Orthopedic Coding Alert

Answer: Code 23466 (capsulorrhaphy, glenohumeral joint, any type multi-directional instability) is used for an open repair and cannot be accurately used to code and bill for an arthroscopic procedure because it describes an open procedure and not an arthroscopic procedure, says Catherine Brink, CMM, CPC, president of Healthcare Resource Management Inc., a practice management and reimbursement consulting firm based in Spring Lake, N.J.

It is incorrect to use an open code for an arthroscopically performed procedure just because there is no arthroscopic procedure code listed to describe the procedure. When there is no specific CPT code listed to accurately describe the service or procedure performed, the unlisted procedure code listed at the end of the anatomical section or type of service performed should be used.

The correct code for the thermal capsular shrinkage is 29909 (unlisted procedure, arthroscopy). This code should be billed with a -59 modifier (distinct procedural service) to indicate it was a distinct and independent procedure from the debridement. Some carriers may require modifier -51 (multiple procedures) be attached to 29909, but you should check with the carrier before appending this modifier.

The code for the shoulder arthroscopy and debridement depends on if it was a limited or extensive debridement. Code 29822 should be used for arthroscopy, shoulder, surgical; debridement, limited. Code 29823 should be used for arthroscopy, shoulder, surgical; debridement, extensive, depending on the documentation in the operative report.

The American Academy of Orthopedic Surgery (AAOS) is always a good source to obtain reference material. You can contact them on the Internet at www.aaos.org.