CA Release and Acromioplasty Confusion

broncsrox

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I've done quite a bit of research (incl this site) trying to distinguish the difference between 23415 and 23130. As yet I have found nothing that clears it up for me. Does the difference have to do with the target intent (i.e. CA ligament had to be released in order to do the acromioplasty therefore it should be 23130)? Is there a general verbiage I should look for in the body of the note that indicates which one to use? Our providers do this procedure quite a bit and in most cases do both a CA release and an acromioplasty. I am aware that both codes are CCI edits incl with RCR so I am not questioning the difference in those cases.

Would greatly appreciate as many opinions as possible!

Thanks! :)
 

JMeggett

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I've done quite a bit of research (incl this site) trying to distinguish the difference between 23415 and 23130. As yet I have found nothing that clears it up for me. Does the difference have to do with the target intent (i.e. CA ligament had to be released in order to do the acromioplasty therefore it should be 23130)? Is there a general verbiage I should look for in the body of the note that indicates which one to use? Our providers do this procedure quite a bit and in most cases do both a CA release and an acromioplasty. I am aware that both codes are CCI edits incl with RCR so I am not questioning the difference in those cases.

Would greatly appreciate as many opinions as possible!

Thanks! :)

I'm getting the below info from another Ortho website, and hopefully it helps! :)

This is from Advance for health Care Professionals:

Coding Q&A: Sept. 12, 2006

Q: What is the difference between CPT codes 23130 and 23415? The narrative descriptions for both procedures appear to have the same intent.

A: The code 23130 is for a partial acromioplasty or acromionectomy, with or without coracoacromial ligament release. The code 23415 is for a coracoacromial ligament release, with or without acromioplasty. According to the Coders Desk Reference for code 23130 "this procedure is also commonly performed during repair to the rotator cuff in an effort to increase the space below the acromion where the cuff tendons traverse toward their insertion on the humerus."

While there are similarities to these codes the subheading also defines the differences. Code 23130 is listed under the "excision" heading while 23415 is listed under the "repair, revision, and/or reconstruction" section.
23415 is for a tight ligament where as 23130 is for a tight space (compressed) and in order to get to the space many times the ligament needs to be cut.

Two similar codes - selection is based on ICD-9 presentation


Jenna
 
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