Wiki Reverse total shoulder and ORIF of proximal humerus fracture with a bone graft


Johnson City, TN
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I cannot wrap my brain around how to bill this to Medicare Cahaba GBA. My physician did a reverse total shoulder replacemement plus an ORIF of a the proximal humerus where a piece of bone was fragmented, not allowing for a "good sleeve of bone around the bony ingrowth section". CCI edits indicate that 23472 is bundled with 23615. That I don't get either when 23472 is by far the larger the procedure, but they are not bundled the other way around. In addition, my doctor did an excellent job of explaining that the procedure was more difficult due to the bony deficiency of the glenoid and the humerus, and the requirement for bone grafting and ORIF. He indicated it took an additional 45 minutes of intraoperative time than a standard reverse total shoulder.

My question out there is this...would you code it 23472-22 RT, 23615-59 RT and 20902-51RT. I do not want Medicare to pay my lesser code (23615) instead of the 23472. Do you think that 23615 should not be billed at all if I use the 22?

Please...any advice is helpful!
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