Wiki CPT code for Bankart Lesion?

Create Wiki
CPT code for Bankart Lesion

new2ortho said:
What CPT code does your office use for a Bankart lesion repair? Fixed at 3:00 -- 5:30 positions. Thanks!
Click to expand...

Take a look at this one:

BANKART LESION REPAIR
One type of labral tear is known as a Bankart lesion. Within the shoulder capsule there are a number of ligaments that act as restraints, reinforcing the shoulder joint holding the humeral head in the glenolabral cup or socket. At the front lower portion of the shoulder (anteroinferior) - you will find the inferior glenohumeral ligament. When this ligament fails during a dislocation injury, the humeral head will push down towards the front of the shoulder tearing the labrum resulting in a Bankart lesion. Typical symptoms of a Bankart lesion include joint instability or repeat dislocations with a popping sound and/or mechanical catching within the joint. Repair of a Bankart lesion can be accomplished by either an open procedure or arthroscopic technique.

The CPT codes are as follows;

23455 – Capsulorrhaphy, anterior; with labral repair (Bankart procedure)
There are parenthetical notes under this CPT code that instruct a coder to report 29806 for the arthroscopic procedure.

29806 – Arthroscopy, shoulder, surgical; capsulorrhaphy
 
I have a question regarding a Bankart tear and a SLAP. I have never been able to fully understand these codes especially together. I know that AAOS says I can bill 29806 and 29807 together as long as I have a SLAP type 2/4 tear, and I also have to have a capsular defect to support my coding for 29806. my question is, if I have a Bankart tear, and a SLAP does this mean I have enough to support both codes here? Does the Bankart tear mean I have a capsule defect? My doc did repair both of these with different anchors.
 
I would say that if your physician has documented either SLAP type two or four you would be OK. But I would have you focus in a different direction. Most insurance companies follow CMS NCCI guidelines. And there is still an edit between 29806 and 29807. If you are billing Medicare, Advantage plan or any private insurance that follows CMS guidelines only 29806 will be considered for benefits and 29807 will be denied. Before billing these two codes together you need to look at the insurance you are billing. In this case probably 95% follow Medicare. AAOS may allow it, but if the insurance is following CMS...
 
Last edited:
npricercm said:
CPT code for Bankart Lesion



Take a look at this one:

BANKART LESION REPAIR
One type of labral tear is known as a Bankart lesion. Within the shoulder capsule there are a number of ligaments that act as restraints, reinforcing the shoulder joint holding the humeral head in the glenolabral cup or socket. At the front lower portion of the shoulder (anteroinferior) - you will find the inferior glenohumeral ligament. When this ligament fails during a dislocation injury, the humeral head will push down towards the front of the shoulder tearing the labrum resulting in a Bankart lesion. Typical symptoms of a Bankart lesion include joint instability or repeat dislocations with a popping sound and/or mechanical catching within the joint. Repair of a Bankart lesion can be accomplished by either an open procedure or arthroscopic technique.

The CPT codes are as follows;

23455 – Capsulorrhaphy, anterior; with labral repair (Bankart procedure)
There are parenthetical notes under this CPT code that instruct a coder to report 29806 for the arthroscopic procedure.

29806 – Arthroscopy, shoulder, surgical; capsulorrhaphy
Click to expand...
I agree with these two codes.
 
You must log in or register to reply here.
Top