I think most would code it as 23470, the problem is the humeral head is not removed. CPT Assistant might have guidance if you have access.
I have found an article under the orthopedic aapc but I do not have access to it. This is stating from a provider that this should be billed as a total shoulder or a hemi. Orthopedic Coding Alert 10/25/2005.
The article says this but it's 18 years old:
Coding for this new surgery shouldn't differ from standard shoulder hemiarthroplasties
Most orthopedic coders consider shoulder hemiarthroplasty coding a piece of cake: They scrutinize the op report, confirm the procedure and report 23470 (
Arthroplasty, glenohumeral joint; hemiarthroplasty). But what happens when your surgeon dictates a drastically different note for hemiarthroplasty, which doesn't include humeral head removal? Find out with our expert tips.
The Basics: Check Out the Op Report
Be on the lookout for operative reports that look like the following note, which describes the new shoulder resurfacing hemiarthroplasty procedure:
-We externally rotated and extended the arm, delivering the humeral head into the wound, and removed the prearticular osteophytes with a rongeur. We placed the trial humeral head into position and inserted a K-wire through the central portion of the humeral head and out the lateral humeral cortex.
-We then used the appropriate-size reverse reamer to remove the articular cartilage from the humeral head down to bleeding cancellous bone. We then used the reamer to make the opening for the post for the Copeland prosthesis.
-We irrigated the entire humeral head with copious amounts of normal saline. We then impacted the appropriate-size Copeland humeral head resurfacing prosthesis onto the humeral head. We inspected the gleno-humeral joint and found that no loose bodies or bone were in the joint. We then reduced the humeral head into the glenoid fossa, and closed the incision.-
Check Out Your Coding Options
Coding concern: -Many coders would do a double-take when they see no mention of the humeral head being removed, which is standard practice in a normal hemiarthroplasty of the shoulder,- says
Heather Corcoran, coding manager at CGH Billing in Louisville, Ky. -Therefore, a lot of coders are tempted to use an unlisted-procedure code or to downgrade 23470 with modifier 52 (
Reduced services).-
Nail Down the Coding Rationale
Coding solution: You should simply report 23470 with no modifiers appended, says
Bill Mallon, MD, a practicing orthopedic surgeon and the medical director at Triangle Orthopaedic Associates in Durham, N.C.
-You should use the same code because the new procedure is a hemiarthroplasty,- says Mallon, who has performed the new resurfacing procedure twice so far. Although 23470 describes a hemiarthroplasty, CPT does not specifically mandate the technique that you must use to report the code, so you should bill 23470 for either type of shoulder hemiarthroplasty.
Know What to Look for in the Notes
The new procedure is often referred to as the -Copeland- hemiarthroplasty, because Dr. Stephen Copeland of England developed the prosthesis, and the U.S. manufacturer (Biomet) markets the product as the Copeland prosthesis, Mallon says.
DePuy Orthopaedics markets a similar product called the Global CAP. If your surgeon refers to the -Copeland- or -Global CAP- prosthesis, you-ll know that he performed a resurfacing hemiarthroplasty.
Discover Why the Procedures Differ
What's the difference? -In the resurfacing hemiarthroplasty, the humeral head is not cut off, and no reaming or broaching of the humeral shaft is performed,- Mallon says.
-A cheese-grater like spherical concave reamer is applied to the humeral head, and it reams off and smoothes the articular cartilage down to bleeding sub-chondral bone. The prosthesis is then simply impacted (over a guide pin) onto the humeral head.-
Consider Writing a Letter to Your Insurer
Because the resurfacing hemiarthroplasty technique preserves bone, surgeons may choose this option for younger patients who might require multiple revision surgeries during their lifetime.
-If you run into any trouble collecting payment for the new procedure, ask your surgeon to write a letter to the insurer,- Corcoran says. -He should note that he performed a shoulder hemiarthroplasty and therefore deserves payment for 23470. Ask the surgeon to explain the differences between the old technique and the new,- she says.