Orthopedic Coding Alert

The typically used code for reverse shoulder arthroplasties may not earn you as much as 2 alternatives. By: David V. Janeway, MD, president of Orthopaedic Specialists of the Carolinas and director of the Outpatient Orthopaedic Surgery Center at Forsyth Medical Center in Winston Salem, N.C. Coding for shoulder procedures has always been difficult, mainly because of the shoulder's intricate anatomy, the many procedures orthopedists perform on the shoulder -- which often occur during the same operative session -- and the range of codes that are available for reporting shoulder procedures. The good news: Shoulder coding has become easier in the past few years because of the addition of new codes for some of the common shoulder procedures that previously did not have codes. As you know, practitioners develop new surgical procedures and techniques frequently, and new CPT and ICD-9 codes also emerge every year. However, it sometimes takes years to create appropriate CPT codes for the new procedures. Let us attempt to dispel some uncertainty here. Example: The reverse shoulder arthroplasty is a relatively new procedure that has many coders asking questions about the differences between it and the regular shoulder replacement, and how to properly code the procedure. Short explanation: The traditional shoulder arthroplasty replaces a patient's existing anatomy by replacing a ball with a ball, and a socket with a socket. But many of you may wonder: What's the meaning of this reverse total shoulder concept? Reverse total shoulder replaces the ball with a socket and the socket with a ball, thus the "reverse" portion of the term. But some questions still linger, such as "How does that happen" and "Why choose this method?" Syllabus: Let's start with some history of the reverse shoulder, then review the anatomy of the shoulder, and then find out how the reverse shoulder really works. Increase Shoulder Anatomy Understanding With This Tutorial Widespread use of the reverse shoulder in the U.S. has only occurred in the last few years. But doctors have performed it in Europe, and especially in France, for much longer. Dr. Paul Grammont designed the first modern working device, and all prostheses in use in the U.S. are similar to this design. Physicians performed more than 20,000 shoulder arthroplasties in 2007. Because of the aging baby boomers, it is estimated that the number will increase to more than 60,000 by the year 2020. The number of total shoulder replacements pales in comparison to total hips and knees. Estimates indicate more than 700,000 hip and knee replacements per year. Anatomy breakdown: The anatomy of the shoulder allows for a very large range of motion about the body. A healthy shoulder has forward flexion of 180 degrees, abduction to 160 degrees, [...]