Wiki Reverse total shoulder CPt Code

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lewisbr

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Hi all, I wanted to see if anyone has had this same issues, the AAOS states that we should report for a reverse total shoulder 23742 and if extensive work is done above and boyond the reverse total shoulder we can report with -22 modifier, however I have explained this to our physician he has chosen to go with unlisted procedure 23929 which i am not in agreement with any suggestions because i want to report 23472 for the reverse total shoulder.
thanks
 
unlisted procedure codes are to be used when there is no procedure code that matches the work that was performed. The 22 modifier is added when the work performed matches the procedure code but for some reason the work is more intensive or complex than what is intended with the basic procedure.
If the provider performs the work of a procedure but then goes beyond that for additional work and there is no addition code that can be added then I agree with the unlisted code. If the provider performs the work of a procedure but that was more involved than it should have been due to patient circumstances then I would attach the 22 modifier.
I agree with the unlisted for those circumstances because if there is a lack of a code to describe the nature of the procedure then using an unlisted code will show that there is a gap, the use of the 22 modifier indicates that this is an unusual case.
Hopefully this is helpful to you
 
Reverse Total Shoulder

Thanks, for your responses, I am going to submit the way the physician has listed if the op reports warrants it and bill to see what happens thanks again for the input.
 
If the doc performed a reverse TSR and AAOS states to report 23472 I would report the 23472. Insurance companies are aware that docs will submit an unlisted code and use a comparison code that pays more than the code that represents that procedure.
 
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