Part B Insider (Multispecialty) Coding Alert

Published on Sat Jan 14, 2006 PDF

Helpful hint:  Look for Global CAP or Copeland in documentation

If you think that the new shoulder resurfacing hemiarthroplasty procedure requires a modifier, think again. Although this type of hemiarthroplasty doesn't include humeral head removal, 23470 (Arthroplasty, glenohumeral joint; hemiarthroplasty) will suffice. Here's why.

Problem: "Many coders would do a double-take when they see no mention of the humeral head being removed, which is standard practice in a normal hemiarthroplasty of the shoulder," says Heather Corcoran, coding manager at CGH Billing in Louisville, KY. "Therefore, a lot of coders are tempted to use an unlisted procedure code or to downgrade 23470 with modifier 52 (Reduced services)."

Solution: Simply report 23470 with no modifier appended, instructs Bill Mallon, MD, a practicing orthopedic surgeon and the medical director of Triangle Orthopedic Associates in Durham, NC. "You should use the same code because the new procedure is a hemiarthroplasty," says Mallon, who has performed the new resurfacing procedure twice so far. Although 23470 describes a hemiarthroplasty, CPT does not specifically mandate the technique that you must use to report the code, so you can bill 23470 for either type of shoulder hemiarthroplasty.

Tip: If your surgeon refers to the "Copeland" or "Global CAP" prosthesis, you'll know that he performed a resurfacing hemiarthroplasty. The new procedure is often referred to as the Copeland hemiarthroplasty, because Dr. Stephen Copeland of England developed the prosthesis, and the U.S. manufacturer (Biomet) markets the product as the Copeland prosthesis, Mallon says. DePuy Orthopedics markets a similar product called the Global CAP.

The procedural difference: "In the resurfacing hemiarthroplasty, the humeral head is not cut off, and no reaming or broaching of the humeral shaft is performed," Mallon says. "A cheese-grater-like spherical concave reamer is applied to the humeral head, and it reams off and smoothes the articular cartilage down to bleeding subchondral bone. The prosthesis is then simply impacted (over a guide pin) onto the humeral head."