Wiki Conversion of resurfacing arthroplasty to total arthroplasty

[adunlap23]

Hello everyone,

I could use some advice on how to code this procedure.

The patient had a previous shoulder resurfacing procedure performed, where only the damaged portion of the humeral head was replaced with a metal cap. The patient is now undergoing conversion to a reverse total shoulder arthroplasty.

The surgeon describes the case as a “revision of a resurfacing hemiarthroplasty to a reverse total arthroplasty.”

My question is:
Would this be considered a revision arthroplasty (since a prosthetic cap is being removed and replaced), or should it be coded as a primary total shoulder arthroplasty (23472) because the previous implant did not include a ball and stem?

Thank you in advance for your input!

 

[NRaizman]

AAOS has looked at this. There are three ways you can -legitimately- code this. This could be coded as 23472+22 OR 23474-52 in a Medicare/Medicaid patient and could be coded 23472, 23334-59 in a commercial payor. The latter code pair is the best from a reimbursement standpoint and also most closely describes the procedure being done but comes up against an NCCI edit - still it is the most appropriate way of coding.

 

[adunlap23]

AAOS has looked at this. There are three ways you can -legitimately- code this. This could be coded as 23472+22 OR 23474-52 in a Medicare/Medicaid patient and could be coded 23472, 23334-59 in a commercial payor. The latter code pair is the best from a reimbursement standpoint and also most closely describes the procedure being done but comes up against an NCCI edit - still it is the most appropriate way of coding.

This is great information. Thank you for your help!