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Would like opinions please.

  1. #1
    Default Would like opinions please.
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    I have an ortho physician who feels he should be charging 23420. Would like some opinions on this please.
    Rotator Cuff Tear, left shoulder.
    Chronic imipingement syndrome, left shoulder.

    The patient was put in the supine position under general anesthesia and then she was changed to a beach chair position. After preparation and drape of the left shoulder and left arm, an incision was made extending from the edge of the acromion toward the coracoid. The deltoid was split between the medial and lateral head and the split was less than 2 cm, a retention suture was placed at the base of the split so the muscle does not split any further inadvertently.
    The rotator cuff was inspected. The only tear that we noticed was close to the bicipital groove, the edge of the tear was freshened. The biceps tendon-itself looked very good and teh joint was irrigated. No other partial tear was noted by probing underneath teh rotator cuff. At this time, the tear was repaired primarily with nonabsorbable suture. The shoulder was taken to full range of motion with no evidence of impingement or disturbance in the repair. Copious irrigation with Bacitracin irrigation solution and closure layer by layer was performed. She was placed in an arm sling. She tolerated the anesthesia and procedure very well and left the room in stable condition. There were no complications throughout this procedure.

    I feel this is more along the lines of 23415 instead of 23420.
    CPT assistant Feb 2002 page 11 states Code 23420 describes a repair of a complete shoulder (rotator) cuff avulsion, referring to the repair of all three major muscles/tendons of the shoulder cuff.

    Have had another coder here look at this also and she agree's it's not a 23420, but unsure if 23415 covers it, but would appreciate any opinions please.

  2. Default
    Quote Originally Posted by Anna Weaver View Post
    I have an ortho physician who feels he should be charging 23420. Would like some opinions on this please.
    Rotator Cuff Tear, left shoulder.
    Chronic imipingement syndrome, left shoulder.

    The patient was put in the supine position under general anesthesia and then she was changed to a beach chair position. After preparation and drape of the left shoulder and left arm, an incision was made extending from the edge of the acromion toward the coracoid. The deltoid was split between the medial and lateral head and the split was less than 2 cm, a retention suture was placed at the base of the split so the muscle does not split any further inadvertently.
    The rotator cuff was inspected. The only tear that we noticed was close to the bicipital groove, the edge of the tear was freshened. The biceps tendon-itself looked very good and teh joint was irrigated. No other partial tear was noted by probing underneath teh rotator cuff. At this time, the tear was repaired primarily with nonabsorbable suture. The shoulder was taken to full range of motion with no evidence of impingement or disturbance in the repair. Copious irrigation with Bacitracin irrigation solution and closure layer by layer was performed. She was placed in an arm sling. She tolerated the anesthesia and procedure very well and left the room in stable condition. There were no complications throughout this procedure.

    I feel this is more along the lines of 23415 instead of 23420.
    CPT assistant Feb 2002 page 11 states Code 23420 describes a repair of a complete shoulder (rotator) cuff avulsion, referring to the repair of all three major muscles/tendons of the shoulder cuff.

    Have had another coder here look at this also and she agree's it's not a 23420, but unsure if 23415 covers it, but would appreciate any opinions please.
    You are correct in stating it is not 23420;however, 23415 is a coracoacromial ligament release that does not involve the rotator cuff. I would try 23410 (acute) or 23412 (chronic). According to Coding Companion, this procedure is:

    The physician repairs a ruptured rotator cuff. A longitudinal incisionis made along the anterior portion of the shoulder and teh skin is reflected. The deltoid fibers and underlying tissues are divided. The coracoacromial ligament is detached by a transverse incision along the greater guberosity.l The distal frayed edges of the tendon are removed. A trench is chiseled into the humeral bone along the level of the anatomical neck of the humerus. The supraspinatus tendon flap is buried in it. The flap is fixed with sutures tied to the tendon and passed through holes drilled in the bone. The repair is completed with side-to-side sutures of the supraspinatus to the adjacent subscrapularis and infraspinatus tendons. The incison is closed and a soft dressing is applied. Protected motion in a specfic progression of exercises is followed.

    Hope this helps.

    Kim, CPC

  3. #3
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    I agree with kim....I don't see any reconstruction.

  4. #4
    Default Opinions
    Thanks to both of you. I appreciate your feed back. I also agree with the 2 codes you suggested. I will have to ask the Doc about acute or chronic, but am thinking probably chronic as the patient had an accident previously (not current). I had looked at those codes but was unsure. Thanks again!

  5. #5
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    I agree, 23412 would be appropriate (he states chronic)

  6. #6
    Default opinions
    Thanks, now all I have to do is convince the Doc!!!

  7. #7
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    Quote Originally Posted by Anna Weaver View Post
    Thanks, now all I have to do is convince the Doc!!!
    good luck!! What I have done in the past is copy the lay descriptions, delete the CPT code so they cant see if, then had them to the doc and ask them to read each of them and tell me which procedure they performed. Then I show them the codes...They have been BUSTED every time I have taken this approach and I get the pleasure of saying "I TOLD YA SO"

    Mary, CPC, COSC

  8. #8
    Default Opinions
    Quote Originally Posted by mbort View Post
    good luck!! What I have done in the past is copy the lay descriptions, delete the CPT code so they cant see if, then had them to the doc and ask them to read each of them and tell me which procedure they performed. Then I show them the codes...They have been BUSTED every time I have taken this approach and I get the pleasure of saying "I TOLD YA SO"

    Mary, CPC, COSC
    OOOHHH, I like that! Thanks!

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