Orthopedic Coding Alert

Question: We recently had an audit of our surgical coding and were told that if a tendon is placed into a trough or trench we should use 23412, not 23420, even when an acromioplasty is performed. What is the difference between 23412 and 23420?

New York Subscriber

Answer: For 23412 (repair of ruptured musculotendinous cuff [e.g., rotator cuff]; chronic) and 23410 ( acute), the rotator cuff (RTC) tear is either acute or chronic. According to the Coders Desk Reference, for these codes the supraspinatus tendon is buried in the trench chiseled into the humeral bone, and the flap is then fixed with sutures tied to the tendon and passed through holes drilled in the bone. The repair is completed with side-to-side sutures of the supraspinatus to the adjacent subscapularis and infraspinatus tendons. For 23420 (reconstruction of complete shoulder [rotator] cuff avulsion, chronic [includes acromioplasty]), the RTC tear must be a complete or massive tear and the approach should be to reconstruct it, not to repair it. The tear is closed with sutures, and the underside of the humeral head is removed. The tendon is then brought into contact with raw bone and the ends of the sutures are passed through holes drilled through the greater tuberosity and tied over its lateral aspect. Your physicians operative reports should be detailed enough to determine which code to use.

According to the American Academy of Orthopedic Surgeons (AAOS) Complete Global Service Data for Orthopaedic Surgery and the Coders Desk Reference, all of these procedures include an acromionectomy or acromioplasty, so these procedures are never billed separately from the major code. Also, with 23420, all four components of the RTC must be torn. For 23410 or 23412, one or more of the four components of the RTC are torn.