Orthopedic Coding Alert

The following letter to carriers describing the SLAP lesion repair and asking for reimbursement is courtesy of Heidi Stout, CPC, CCS-P, coding and reimbursement manager at University Orthopedic Associates in New Brunswick, N.J.

Dear Sir or Madam:

I am writing in regard to our patient and your policyholder, Jane Doe. On (insert date) I performed an arthroscopic repair of a SLAP lesion on Ms. Does right shoulder. Because there is no CPT code for arthroscopic repair of a SLAP lesion of the shoulder, I am reporting the unlisted procedure code for arthroscopy, 29909.

This procedure is similar to a Bankart type operation with or without stapling (23455). The pathology consists of a separation of the biceps-labrum complex at the superior aspect of the glenoid. The procedure involves a repair of this biceps-labrum complex separation and is performed by a direct repair of the structures to the glenoid bone surface. However, this procedure is technically more demanding than an open Bankart repair. The procedure differs from code 23455 in that:

The procedure is performed arthroscopically and requires the technical skill of arthroscopic visualization at the superior aspect of the glenoid.

The insertion of fixation devices can be difficult to perform arthroscopically.

I estimate the arthroscopic repair of a SLAP lesion is 10 percent more difficult; therefore, I request that you approve reimbursement equal to 110 percent of your fee schedule amount for CPT code 23455 for this procedure.

A copy of my operative report is attached. If you need any additional information, please do not hesitate to contact me.

Sincerely yours,


ORTHOPEDIC SURGEON, MD