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Help coding calcific tendinitis

  1. #1
    Default Help coding calcific tendinitis
    Medical Coding Books
    I have an op note that states that they did an excision on the calcification of the shoulder but they also did acromioplasty. I am having a hard time figuring out which code(s). I am torn between 23130 and 23415. The 23130 is only a partial acromioplasty but the 23415 mentions the ligament release so I am wondering if either or both codes are even accurate. Please, any advice or help would be appreciated.

    Here is some of the op note:

    The bursa was thickened and acutely inflammed overlying the rotator cuff. This was excised in the superior aspect. The underlying rotator cuff was grossly inflamed with a large calcific deposit at the junction between the supraspinatus and infraspinatus tendons. There was a large oteophyte off the anterior acromion, and this was resected with an osteotome. There was a large osteophyte off the AC joint. This was removed with a rasp. I then made a small incision with a 15 blade, and the calcific deposit was curetted and debride from the tendon. There was considerable degeneration of this section of the rotator cuff tendon. I did excise some of the tendon that was abvioulsy dissected. I then carried out a repair in a side-to-side fashion with interrupted #1 vicryl sutures. The wound was copiously irrigated. I injected 10 ml of ropivacaine into the rotator cuff and then another 10 ml into the subcutaneous tissues.

  2. #2
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    Quote Originally Posted by LeslieTibbetts View Post
    I have an op note that states that they did an excision on the calcification of the shoulder but they also did acromioplasty. I am having a hard time figuring out which code(s). I am torn between 23130 and 23415. The 23130 is only a partial acromioplasty but the 23415 mentions the ligament release so I am wondering if either or both codes are even accurate. Please, any advice or help would be appreciated.

    Here is some of the op note:

    The bursa was thickened and acutely inflammed overlying the rotator cuff. This was excised in the superior aspect. The underlying rotator cuff was grossly inflamed with a large calcific deposit at the junction between the supraspinatus and infraspinatus tendons. There was a large oteophyte off the anterior acromion, and this was resected with an osteotome. There was a large osteophyte off the AC joint. This was removed with a rasp. I then made a small incision with a 15 blade, and the calcific deposit was curetted and debride from the tendon. There was considerable degeneration of this section of the rotator cuff tendon. I did excise some of the tendon that was abvioulsy dissected. I then carried out a repair in a side-to-side fashion with interrupted #1 vicryl sutures. The wound was copiously irrigated. I injected 10 ml of ropivacaine into the rotator cuff and then another 10 ml into the subcutaneous tissues.
    **

    You can code all procedures using those cpt. If outpatient you code the cpt and ICD-9 vol 3 codes and with Inpatient Only you would code use ICD book volume 1,2,&3 with using the Vol 3 procedures codes.

    If you hav calcification you should code those as well as the acromioplasty and the ligament release . Sometimes in coding cpt, u may have to use the same code more than once depending on what the code book rules are to a particular code and also use your modifier -51 if more than one procedure or what it allows you to use. Good luck!!

  3. #3
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    Leslie,

    Which code did you plan to use for the side to side rotator cuff repair? you may not need to worry about it due to bundling

    Mary

  4. #4
    Default
    I wasn't sure what to do about the side-to-side code. I am still trying to figure out what is bundled with what. I was hoping to hear back from you specifically, though, as to what you thought about it. I value your advice and input. We are critical access also so I didn't know if that factured in as well.

  5. #5
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    ENGLEWOOD/DENVER
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    Quote Originally Posted by LeslieTibbetts View Post
    I wasn't sure what to do about the side-to-side code. I am still trying to figure out what is bundled with what. I was hoping to hear back from you specifically, though, as to what you thought about it. I value your advice and input. We are critical access also so I didn't know if that factured in as well.
    Leslie I sent you a private message
    Mary

  6. #6
    Default Tibbs20
    Mary, I just spoke to someone that used to code ortho here that I had also asked about this op note and she came up with 23130 only, stating that there wasn't actually a rotator cuff repair done. She also came up with 23000 but since it is included with 23130, she dropped it and just went with the 23130. Do you agree? I thought that the side-to-side repair and the fact that some of the tendon was excised would indicate a repair.

  7. #7
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    ENGLEWOOD/DENVER
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    Quote Originally Posted by LeslieTibbetts View Post
    Mary, I just spoke to someone that used to code ortho here that I had also asked about this op note and she came up with 23130 only, stating that there wasn't actually a rotator cuff repair done. She also came up with 23000 but since it is included with 23130, she dropped it and just went with the 23130. Do you agree? I thought that the side-to-side repair and the fact that some of the tendon was excised would indicate a repair.
    The op note justifies using the 59 modifier for the 23000. I agree that the 23000 is the better choice for the side to side repair.

    so for this case the codes would be:
    23130
    23000-59

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