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Wiki shoulder surgery

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megan@sdorthopedics

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What is the difference between CPT: 23412 & 23130? Can you bill for both? It seems like they
overlap?
 
It's two totally different procedures... Not sure what you mean, are you asking about bundling? The difference is 23412 is open rotator cuff repair for a chronic tear while 23130 is partial acromioplasty.
However, these are done concurrently almost every time. It's the same idea as 29827/29826 via scope. If you don't have a coding program you can check edits with a tool like this: https://www.cgsmedicare.com/medicare_dynamic/j15/ptpb/ptp/ptp.aspx or go to the CMS NCCI page: https://www.cms.gov/medicare-medicaid-coordination/national-correct-coding-initiative-ncci

I believe there are CPT assistant articles you can also check.

Many payers won't allow the SAD. Example: https://guidelines.carelonmedicalbenefitsmanagement.com/joint-surgery-2022-09-11/

Subacromial impingement syndrome: Subacromial decompression/acromioplasty is considered not medically necessary for all indications.​

 
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