Orthopedic Coding Alert

Knowledge of anatomy is crucial When you have a solid idea of where the shoulder parts are located and how they fit together, reporting a rotator cuff repair (RCR) is easy. The rotator cuff is a series of four muscles that surrounds the gleno-humeral joints -- almost completely. The muscles are:

- Subscapularis

- Supraspinatus

- Infraspinatus

- Teres minor. The subscapularis is the largest muscle and is anterior. The supraspinatus is the muscle most commonly torn and is superior. The infraspinatus and teres minor are the posterior muscles.

The term -the rotator interval- is the antero-superior space between the anterior edge of the supraspinatus and the superior edge of the subscapularis, and is the only space where the rotator cuff doesn't completely invest the gleno-humeral joint.

The interval between the supraspinatus and the infraspinatus is often termed the -posterior rotator interval,- and physicians sometimes have difficulty telling where one muscle tarts and one ends when performing arthroscopic surgery.

Learn these seven CPT codes for RCR:

- 23130 -- Acromioplasty or acromionectomy, partial, with or without coracoacromial ligament release

- 23410 -- Repair of ruptured musculotendinous cuff (e.g., rotator cuff) open; acute

- 23412 -- - chronic

- 23415 -- Cocacoacromial ligament release, with or without acromioplasty

- 23420 -- Reconstruction of complete shoulder (rotator) cuff avulsion, chronic (includes acromioplasty)

- 29826 -- Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with or without coracoacromial release

- 29827 -- Arthroscopy, shoulder, surgical; with rotator cuff repair. Look at the Options When Coding RCRs Since the late 1990s, surgeons have been able to perform arthroscopic rotator cuff repairs. Some doctors, not yet fully versed in arthroscopic techniques or for matters of personal preference, perform a -mini-open rotator cuff repair.-

In this technique, the surgeon performs an arthroscopic acromioplasty and prepares the cuff edges and bony attachment arthroscopically. The physician then makes a small incision, often only 1.5-3 centimeters, and repairs the tendon using bony suture anchors.

Know Acute and Chronic Repairs For open procedures, you may be confused as to when you should use 23410, 23412 or 23420. Part of this depends on the definition of -acute.-

For most coding situations, -acute- describes an injury less than three months old. Unless your surgeon specifically documents that the patient's injury occurred less than three months from the date of surgery, you probably use 23412 in most cases. But When Would You Use 23420 for Open Repairs? There are no hard and fast guidelines. One thing to remember is that more than one rotator cuff tendon can be torn. These are often termed as two-tendon tears or three-tendon tears, and rarely four-tendon, or massive, tears -- although those are often irreparable. Use 23420 for any multi-tendon repair, which needs to be documented by the surgeon. There is no extra code for repairing more than [...]