Question Bicep Tendon Tenodesis?

JoannaParz

Contributor
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10
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Union, New Jersey
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Hello all,

A few of my providers are billing a Biceptal Tenodesis CPT 23430 and Total Shoulder Arthroplasty CPT 23472 but I don't feel that their documentation supports this. For one the definition of a tenodesis is the repair of a tendon to a bone and this is not being done in these cases.

Does anyone know what code we should bill when the bicep tendon is being repaired to the pectoralis muscle, or what my physician is calling a "soft tissue tenodesis"?

"The shoulder was brought in external rotation and the anterior humeral circumflex vessels were identified and coagulated and then cut with cautery. I then bluntly developed the plane between the subcapularis muscle belly and the anterior capsule using initially a Freer elevator followed by increasingly large Cobb elevators. I then opened the biceptal sheath and release the rotator interval to the base of the coracoid. The long head of the biceps was found to have significant tenodesis and partial tearing. Biceps synovectomy was performed. With the bicep out to length, it was repaired to the backside of the pectoralis using 2 Ethibond inverted mattress sutures. The proximal biceps was the resected.”

Any help is greatly appreciated! Thank you!
 

Orthocoderpgu

True Blue
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1,379
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Salt Lake City, UT
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The first thing you need to do is check what insurance you are dealing with. CMS bundles the tenodesis. AAOS does not. So if the patient has Medicare, or an insurance that follows CMS policy, then it would be included with the TSA. If not, and there is significant pathology, such as tendonitis and tearing, I would consider using the -52 modifier for the tenodesis since the tendon is not being anchored down to bone.
 

JoannaParz

Contributor
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Union, New Jersey
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Yes the patients are noted to have tenodesis when this is performed so modifier 59 would work.

Modifier 52 is a great idea, not sure if we would get paid but we'll give it a shot since I couldn't find another code that would work for this kind of repair.

thank you again for your help!
 
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