Wiki Infected Total Shoulder Arthroplasty

[Joyce Burchett]

Patient has systemic bacteremia with septic arthritis of total shoulder arthroplasty. The physician examined the glenoid component & there was significant wear of the polyethylene component with the posterior 3rd being completely worn down to the metal-backed glenoid which was causing metallosis. The glenoid component was removed due to acute infection. Examined the humeral stem to see if this was loose. It was very stable & well fixed & it was elected not to remove the humeral stem since it was in a very stable position & alignment. The prosthetic humeral head was replaced with the head of the same size. The patient will require revision arthroplasty of his shoulder at a later date. Removal of glenoid component was very difficult. There was significant metal debris & metallosis & synovium debrided but there remained metal debris in the joint capsule in various places. Glenoid not replaced at this time.

Need help for coding this procedure ASAP. Don't know if should use 23334 or 23473 with a modifier of 52 or 22. Can't bill 23334 & 23473 due to bundling. Not sure if removal & replacement of the humeral head is significant to consider as a revision since the glenoid component was removed & not replaced due to infection & only the humeral head was exchanged.

 

[pwebbabshire@cox.net]

In 23334, the component is not replaced, so I would not use that code. For 23473, this code is used if humeral OR glenoid component is replaced. He did replace the Humeral head, so I would think you could use this code. Don't forget your global modifiers it patient is within the 90 days of the arthroplasty.