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Thread: Total Shoulder w/ RCR

  1. #1
    Join Date
    Apr 2007
    Long Island/New York

    Default Total Shoulder w/ RCR

    AAPC: Back to School
    Can anyone point me in the right direction for an article so I can show that a Rotator Cuff repair is inclusive in a Total Shoulder. He thinks that there can be a separate occasion (i.e arthritis + RC tear) that would allow for the 23412 to be billed along with 23472. Thanks.

    I just want to make things clearer for him as this is a Medicare patient.

  2. #2

    Smile Total Shoulder and Rotator Cuff Repair

    Not sure if you have the Encoder so I am copying and pasting the description of the Total Shoulder code...please note the comment near the end of the descriptor where it talks about "IF LARGE ROTATOR CUFF TEARS ARE FOUND, THEY ARE REPAIRED AT THIS TIME" making them all inclusive.

    Hope this helps!


    A total shoulder replacement is done for the glenohumeral joint. A long curved incision is made from the superior aspect of the acromion along the deltopectoral interval to the deltoid insertion. The deltoid is retracted laterally and pectoralis medially. The fascia between the pectoralis and the clavicle is divided and the subacromial space is freed with a gloved finger or periosteal elevator. The coracoacromial ligament is freed and often an acromioplasty is performed to allow for freedom of movement after surgery. The subscapularis tendon is tagged and removed from the capsule. The anterior joint capsule is divided and the glenohumeral joint is dislocated by further external rotation and extension of the arm. The joint is explored and all loose bodies are removed. The humeral head is removed with a reciprocating saw or osteotome. In addition, a prosthetic device is placed proximally at the glenoid to articulate with the prosthetic humeral head. Prior to placement of the humeral prosthesis, the joint is opened to fully expose the glenoid surface. The surface cartilage of the glenoid is removed. A power drill is used to cut a slot into the glenoid the exact size of the holding device of the glenoid component. Small curettes are used to remove cancellous bone from the base of the coracoid bone. With a bur, articular cartilage is removed from the surface of the glenoid. A trial glenoid component is used to properly prepare the bone and fit the prosthesis. Once the glenoid preparation is complete, the glenoid vault is drilled and filled with polymethylmethacrylate (bone cement). The glenoid component is pushed into place and held until the cement is cured. Prior to final insertion of the humeral component, an anterior acromioplasty and acromioclavicular arthroplasty are performed, if necessary. If large rotator cuff tears are found, they are repaired at this time. The joint is brought through a full range of motion and fully irrigated. The subscapularis tendon is repaired to stabilize the joint; however, the joint capsule is not usually resutured. Drains are placed and the deltopectoral interval is sutured closed. The arm is placed in a sling and swathe.

  3. #3
    Join Date
    Apr 2007
    Long Island/New York


    No on Encoder but CodeX has 23412 as NOT included in 23472. That's what can be confusing even though Medicare NCCI edits don't allow it. Just can't find good article on AAOS or Medicare to show my Dr. Thanks.

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