Orthopedic Coding Alert

Although new CPT Codeswere released for arthroscopic shoulder procedures in 2002 coders are still puzzled about how an arthroscopic Bankart repair should be reported. Both the American Medical Association (AMA) and the American Academy of Orthopaedic Surgeons (AAOS) have issued guidance to resolve this issue. Although at times contradictory the advice should help coders determine how best to report Bankart and SLAP lesion repairs.

The shoulder is a ball-and-socket joint with the humeral head being the ball and the glenoid being the shallow socket. The glenoid labrum is the fibrocartilaginous ring that surrounds the glenoid. It deepens the shoulder socket and helps stabilize the joint. Bankart and SLAP lesions are both stretching or tearing injuries to the glenoid labrum of the shoulder. Tears of the glenoid labrum can run from top to bottom (superior to inferior) or front to back (anterior to posterior). A SLAP lesion (superior labrum anterior [front] to posterior [back]) is a tear of the rim above the middle of the socket that may also involve the biceps tendon. A Bankart lesion is a tear of the rim below the middle of the glenoid socket that also involves the inferior glenohumeral ligament. Tears or lesions of this type often occur together or with shoulder dislocation and rotator cuff tears. They often occur as a result of a fall on an outstretched arm. In throwing sports such as baseball football etc. injuries of this type are extremely common.

Many SLAP and Bankart repairs can be accomplished arthroscopically advances in arthroscopic techniques and equipment enable surgeons to visualize the affected area with minimal incision and trauma to the patient. The physician repairs the injury by either removing the torn tissue suturing it back into place or if the labrum has pulled away from the socket entirely reattaching it with suture anchors.

The ICD 9 Code for a SLAP lesion is 840.7 (Superior glenoid labrum lesion). No specific diagnosis code exists for a Bankart lesion. In the absence of a specific code use 718.81 (Other joint derangement not elsewhere classified; shoulder region).

Until recently no specific CPT codes existed for arthroscopic Bankart or SLAP lesion repairs. But CPT 2002 introduced 29806 (Arthroscopy shoulder surgical; capsulorrhaphy) and 29807 ( repair of slap lesion).These new codes presumably signaled an ease in documentation and reimbursement because coders would no longer have to submit unlisted procedure codes with extensive documentation. But five months later confusion still exists regarding whether 29806 is the correct code for the Bankart.

Kathy Davis CPC orthopedic coder in Jacksonville Fla. reports that she has obtained conflicting information from the AMA (publishers of CPT) and the AAOS concerning use of the Bankart and SLAP codes. I spoke to a representative from the AMA who instructed me to use 29807 for both the SLAP and the Bankart repairs " says Davis. "Plus my physicians do not feel that 29806 is the appropriate code for a Bankart." Yet the AAOS advises that 29806 is the correct code for the Bankart procedure.

Davis says her physicians have reviewed the codes and feel that because there is no mention of the labrum in the code descriptor 29806 is not the code for a Bankart lesion repair. Instead she is submitting 29807 for both Bankart and SLAP repairs and using 29806 to report multidirectional procedures (multidirectional instability is a condition where the patient dislocates in more than one direction) and repairs for instability and/or capsular laxity none of which involve the labrum.

A conflicting report from the AAOS' 2002 Complete Global Service Data Guide indicates that 29806 includes anterior capsulorrhaphy (e.g. Bankart Putti-Platt Magnuson) posterior capsulorrhaphy and thermal capsulorrhaphy. Heidi Stout CPC CCS-P coding and reimbursement manager at University Orthopedic Associates in New Brunswick N.J. says that the descriptors are saying one thing but that the AMA says another. "Because of the way the descriptors are written " says Stout "I infer that 29807 should be reported only for arthroscopic repair of a SLAP lesion whereas 29806 should be reported for any other type of arthroscopic capsular repair including a Bankart." Stout contacted the AMA's CPT Information Service seeking to resolve the challenge. "I was told that the descriptors for CPT codes 29806 and 29807have caused tremendous controversy in the coding community and that they will likely be amended in the future to alleviate the confusion " Stout says. She learned that the AMA's position is that although the descriptor associated with 29807 is "Arthroscopy shoulder surgical; repair of SLAP lesion " the code should be reported for the arthro-scopic repair of any labral lesion including a Bankart lesion. Code 29806 is for any arthroscopic capsular repair that does not involve repair of the glenoid labrum.

The AMA's position on 29806 is clear and until the organization indicates otherwise the code is not for reporting an arthroscopic Bankart repair. Orthopedic Coding Alert will keep readers updated on this important coding debate.