esimonsen
Guest
Help please please please! Our coding service said one of our docs is reporting a bunch of coding for a reverse shoulder arthroscopy that they say are bundled. I am not finding any NCCI edits, and I don't know if that means that it is such a "duh" bundle that they don't have an edit for it, or if I am just not well versed enough in shoulder and so don't get it. Is he just saying the same thing twice by reporting all these codes plus the reverse shoulder?
the feedback we received was "The provider is indicating to code the following CPT codes 24400 (lesser tuberosity osteotomy), 23630 (open reduction internal fixation of tuberosity osteotomy) and 23020 (capsular contracture release of entire subscap off anterior scapula) as well as 23430 (tenodesis of the long head of biceps,) in addition to 23472 (total shoulder). Based upon the coding review of the documentation only the total shoulder CPT 23472 would be appropriate to code. I wanted to bring this to your attention to see if the provider feels there is something different with these cases where the coding should be unbundled?"
POSTOPERATIVE DIAGNOSES:
1. M19.012: Left shoulder osteoarthritis.
2. S43.022S: B2 Walch posteriorly subluxed humeral head on the glenoid.
OPERATION:
1. 23472: Total shoulder arthroplasty with Simplicity humeral component and
shoulder Innovations inset glenoid component, 8 mm depth.
2. 24400: Lesser tuberosity osteotomy.
3. 23630: Open reduction internal fixation of tuberosity osteotomy.
4. 23020: Capsular contracture release of entire subscapularis off anterior scapula.
5. 23430: Tenodesis of the long head of biceps.
PATHOLOGY: This patient had osteoarthritis with a fixed posterior subluxation
of the humeral head with a B2 posteriorly eroded glenoid. The rotator cuff
was intact.
DESCRIPTION OF PROCEDURE: The patient was placed on the operative table.
After the timeout ritual, a left deltopectoral incision was carried through
the skin, subcutaneous tissue and deltopectoral interval while preserving the
cephalic vein with the deltoid. The subacromial, subdeltoid and subcoracoid
spaces were freed. The long head of the biceps was tenodesed to the upper
pectoralis and then resected proximal to that. The lesser tuberosity was
osteotomized and retracted as the inferior capsule was released. The rotator
interval was opened. The head was delivered to the deltopectoral interval.
Marginal osteophytes were removed and with the ring cutting guide. The head
was osteotomized at the anatomic neck with the #2 nucleus and trialing the 46
mm humeral head fit best. The triflange nucleus was impacted in place. A cut
protector was put on this. The head was retracted posteriorly. The glenoid
was exposed. The coracohumeral ligaments and the entire anterior capsule were
excised, as the subscapularis was elevated off of the anterior scapula.
Aiming for Matsen's center point along Friedman's line, the version was
corrected using a Steinmann pin and a reamer with the next largest size of the
reamer. It was reamed so that eversion would be restored closer to neutral.
It was inset deeper into the anterior glenoid than the posterior glenoid. The
3 drill holes were created for the inline pegs to be cemented.
After the cement dried, 3 holes were made in the biceps groove. Nice loop
sutures were passed through the drill holes. The prosthesis was impacted into
place. The shoulder was reduced. The lesser tuberosity was repaired by
passing these sutures medial to the lesser tuberosity osteotomy, and then
racking hitch sutures were used to secure the tuberosity securely back to the
humerus. The rotator interval was partially closed.
The deep and superficial tissues were closed over vancomycin powder.
Steri-Strips were used for the skin. The patient was transferred to Recovery
Room in good condition.[/SIZE]
the feedback we received was "The provider is indicating to code the following CPT codes 24400 (lesser tuberosity osteotomy), 23630 (open reduction internal fixation of tuberosity osteotomy) and 23020 (capsular contracture release of entire subscap off anterior scapula) as well as 23430 (tenodesis of the long head of biceps,) in addition to 23472 (total shoulder). Based upon the coding review of the documentation only the total shoulder CPT 23472 would be appropriate to code. I wanted to bring this to your attention to see if the provider feels there is something different with these cases where the coding should be unbundled?"
POSTOPERATIVE DIAGNOSES:
1. M19.012: Left shoulder osteoarthritis.
2. S43.022S: B2 Walch posteriorly subluxed humeral head on the glenoid.
OPERATION:
1. 23472: Total shoulder arthroplasty with Simplicity humeral component and
shoulder Innovations inset glenoid component, 8 mm depth.
2. 24400: Lesser tuberosity osteotomy.
3. 23630: Open reduction internal fixation of tuberosity osteotomy.
4. 23020: Capsular contracture release of entire subscapularis off anterior scapula.
5. 23430: Tenodesis of the long head of biceps.
PATHOLOGY: This patient had osteoarthritis with a fixed posterior subluxation
of the humeral head with a B2 posteriorly eroded glenoid. The rotator cuff
was intact.
DESCRIPTION OF PROCEDURE: The patient was placed on the operative table.
After the timeout ritual, a left deltopectoral incision was carried through
the skin, subcutaneous tissue and deltopectoral interval while preserving the
cephalic vein with the deltoid. The subacromial, subdeltoid and subcoracoid
spaces were freed. The long head of the biceps was tenodesed to the upper
pectoralis and then resected proximal to that. The lesser tuberosity was
osteotomized and retracted as the inferior capsule was released. The rotator
interval was opened. The head was delivered to the deltopectoral interval.
Marginal osteophytes were removed and with the ring cutting guide. The head
was osteotomized at the anatomic neck with the #2 nucleus and trialing the 46
mm humeral head fit best. The triflange nucleus was impacted in place. A cut
protector was put on this. The head was retracted posteriorly. The glenoid
was exposed. The coracohumeral ligaments and the entire anterior capsule were
excised, as the subscapularis was elevated off of the anterior scapula.
Aiming for Matsen's center point along Friedman's line, the version was
corrected using a Steinmann pin and a reamer with the next largest size of the
reamer. It was reamed so that eversion would be restored closer to neutral.
It was inset deeper into the anterior glenoid than the posterior glenoid. The
3 drill holes were created for the inline pegs to be cemented.
After the cement dried, 3 holes were made in the biceps groove. Nice loop
sutures were passed through the drill holes. The prosthesis was impacted into
place. The shoulder was reduced. The lesser tuberosity was repaired by
passing these sutures medial to the lesser tuberosity osteotomy, and then
racking hitch sutures were used to secure the tuberosity securely back to the
humerus. The rotator interval was partially closed.
The deep and superficial tissues were closed over vancomycin powder.
Steri-Strips were used for the skin. The patient was transferred to Recovery
Room in good condition.[/SIZE]
