Wiki Total shoulder

[Jennifer17]

my doctor wants to bill 23430 and 23420 along with the total arthroplasty 23472, can this be done?

Thanks!

 

[Orthocoderpgu]

Have you checked the NCCI edits?

 

[cclarson]

my doctor wants to bill 23430 and 23420 along with the total arthroplasty 23472, can this be done?

Thanks!

No, as per NCCI Edits, those two procedures would be considered bundled into the total shoulder arthroplasty. A total shoulder arthroplasty is often done when a patient has a massive irreparable rotator cuff tear, and any work on the biceps would be included.

 

[nishats.aapc@ascent-group.com]

No, as per NCCI Edits, those two procedures would be considered bundled into the total shoulder arthroplasty. A total shoulder arthroplasty is often done when a patient has a massive irreparable rotator cuff tear, and any work on the biceps would be included.

What modifier's can be used in this case to submit Medicaid MA payer instead of modifier 22. Thanks.

 

[NRaizman]

23420 would be 100% inappropriate 100% of the time. Capsular release is included in the work of total shoulder per GSD and there is no situation in which it would EVER be appropriate to bill a Sever type procedure with a total shoulder. There was some incorrect guidance about that given by an ASES coding webinar that has since been rectified and taken down. This is a clear No.

23430 cannot be billed in a Medicare/Medicaid patient, but can be billed with a -59 modifier in a non-medicare patient.

Unless there is a justification for a -22 modifier, I would not consider using it.