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Open rotator cuff repair and open biceps tenodesis

O

ortho1991

Guru
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175
Location
North Andover, MA
Can you bill open rotator cuff repair 23472 and open biceps tenodesis 23430 at the same opertive session? this happens to be a Medicare pt, but wondering about other insurances also. I have read that you can put a 59 onthe 23430 but not sure if this is correct billing.

Any help will be appreciated.

Thank you, Cathy
 
According to the NCCI edits 23430 is bundled with 23472 but a modifier is allowed. Whether you add the modifier or not would depend on the documentation. However, the AAOS Global Services Data states that 23420 is not included, so coverage by other insurance companies would depend on if they follow NCCI guidelines or CPT guidelines and you would need to check with each of your carriers.
 
It's important to note that Medicare considers the shoulder to be a single anatomical site, so unbundling these services would only be appropriate if performed on different shoulders.
 
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