Orthopedic Coding Alert
Choose Between Acute, Chronic for RTC Repairs
Question: Our surgeon performed an open rotator cuff repair, subacromial decompression, and distal clavicle excision. Which codes should we report? Orthopedic surgeons report that most patients who require this type of surgery have chronic conditions, so 23412 or 23420 is likely the appropriate code. But you should check the surgeon's documentation to determine which type of rotator cuff injury the patient had.
New Jersey Subscriber
Answer: Depending on the patient's condition, you should choose from one of the following three codes for the rotator cuff repair:
If the patient had a chronic condition, determine whether the surgeon repaired (23412) or reconstructed (23420) the rotator cuff.
You should report 23120 (Claviculectomy; partial) for the distal clavicle excision.
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