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Open Rotator Cuff Repair and Coracoacromial Ligament Release w/ Acromioplasty

  1. Default Open Rotator Cuff Repair and Coracoacromial Ligament Release w/ Acromioplasty
    Medical Coding Books
    I was wondering if we could get some resolution on this. It is my understanding the shoulder is composed of two compartments, the glenohumeral and the acromioclavicular. The Rotator Cuff is in the glenohumeral joint and coracoacromial ligament and the acromion is located in the acromioclavicular joint. Why is the 23412 and the 23415 inclusive of each other and why is the the "59" modifier not payable under this circumstance?
    Thank you for your response.
    Ella N

  2. Default
    The coracoacromial ligament release is actually part of 23412 according to Ingenix's "lay description".
    Check your operative report - you may wish to use 23420 which includes the RTC reconstruction, acromioplasty, coracoacromial ligament release etc...

    Ella, The lay descriptions are quite long... I would be happy to e-mail this info to you - just send me your e-mail address. - Have a great day!

  3. #3
    use caution with the 23420 though, it is for a "complete" rotator cuff tear. If I remember correctly three of the four tendons must be repaired. (infraspinatous, supraspinatous, subcapularis, teres minor).

    I very rarely see documentation that supports this code.

  4. #4
    Ella, that's right 23420 is for 'complete' RC repair and you need to have documentation for atleast 3 tendons being repaired out of S.I.T.S
    Also, when you check CCI edits, you would find that 23412 and 23415 are modifier allowed, so in my opinion if you have a supporting separate and distinct dx available and the procedures are being performed distinct enough from each other (via separate portal, etc.), then you should be in a position to report them with 59.

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