Orthopedic Coding Alert

Answer: It sounds as though your practice repaired only one of the four components (supraspinatus, infraspinatus, teres minor, subscapularis) a ruptured supraspinatus muscle of the rotator cuff. Therefore, you should bill 23412 (Repair of ruptured musculo-tendinous cuff [e.g., rotator cuff]; chronic), which applies to chronic repairs involving one or two tendons or major muscles of the rotator cuff.

Code 23420 (Reconstruction of complete shoulder [rotator] cuff avulsion, chronic [includes acromioplas-ty]) refers to the repair of three or four major muscles/ tendons of the shoulder cuff. In your case, this is inappropriate and would be considered upcoding.

Your supporting documentation should indicate the injury's severity, the exact procedure performed, and descriptions of which specific muscles and tendons were involved.