What is procedure code 23412?
Code 23412 is more appropriately used for most of the rotator cuff tears that occur in older individuals who have sustained a tear over time, with or without a superimposed acute episode.
Can 23412 and 29826 be billed together?
Rules: The American Academy/Association of Orthopaedic Surgeons (AAOS) states: “CPT code 29826 should not be reported with any procedure other than those identified as appropriate parent codes. It is not an add-on code to CPT code 23410 or 23412, and an unlisted code may not be reported to reflect this work.
Does CPT code 23412 include acromioplasty?
No. Code 23412 does not include a partial acromioplasty or acromionectomy with or without coracoacromial ligament release. To report such a procedure, use code 23130.
What is the CPT code for mini open rotator cuff repair?
Use CPT code series 23410 to 23412 to report mini open rotator cuff tear repairs, with code selection determined by acute versus chronic conditions.
What is the difference between CPT code 23420 and 23412?
Code 23412 is more appropriately used for most of the rotator cuff tears that occur in older individuals who have sustained a tear over time, with or without a superimposed acute episode. Code 23420 is more frequently use in retraction with a large tear, extensive releases and mobilization.
What is the CPT code for superior capsular reconstruction?
29806
When the surgeon performs both procedures, we recommend 29827 for coding of rotator cuff repair and 29806 for capsular reconstruction. These codes have been previously described and valued through the peer- reviewed RUC and CPT processes.
Can 29826 and 29824 be billed together?
CPT 29826 can only be billed along with one (or more) of the following CPT codes: 29806, 29807, 29819, 29820, 29821, 29822, 29823, 29824, 29825, 29827 and 29828.
Can you bill 29826 alone?
The AAOS Global Service Data Guide for Orthopaedic Surgery (GSD) states specifically that codes 29824, 29826, and 29827 are separately reportable.
Does rotator cuff repair include Acromioplasty?
Acromioplasty and release of the coracoacromial ligament is often included as part of a rotator cuff repair.
Can CPT 29806 and 29827 be billed together?
Now, if the surgeon works on both the upper and lower labrum, you cannot simply unbundle and code both 29806 and 29807. According to the National Correct Coding Initiative (NCCI) edits, 29806 is bundled with the following codes: 29807 − SLAP repair. 29827 − biceps tenodesis.
Can 29827 and 29828 be billed together?
You can bill 29827 & 29828 together as there is no edit that prohibits it. In 2017 CMS stated in the NCCI Surgical Policy Manual that the shoulder is considered “one anatomical” unit or location. As such, when billing Medicare or any insurance that follows their rules, you cannot bill any coding pair that hits an edit.
What is superior capsule reconstruction?
Superior Capsular Reconstruction is an arthroscopic procedure that has been developed for patients with massive irreparable rotator cuff tears. In certain individuals with chronic tears this procedure can be used to improve function and decrease pain in individuals that have failed non-operative management.
What do CPT codes 23410 and 23412 mean?
CPT codes 23410 and 23412 describe musculotendinous cuff (eg, rotator cuff) repairs involving 1 or 2 tendons or major muscles of the rotator cuff. Code 23412 describes repair of a chronic rupture.
How many tendons need to be torn to report CPT 23420?
In addition, three tendons need not be torn to support reporting CPT 23420. Use CPT code series 23410 to 23412 to report mini open rotator cuff tear repairs, with code selec- tion determined by acute versus chronic conditions.
What is the CPT code for mini open rotator cuff?
While CPT provides a parenthetical statement under CPT 29827 (Arthroscopy, shoulder, surgical; with rotator cuff repair) directing the CPT user to report 23412 for mini open rotator cuff repair, you still need to determine the final code selection based on the acute versus chronic condition.
Can You Bill out 23412, 29824 and 29826?
Since the subacromial area had bursitis and there was impingement, so the acromion was debrided, it probably is. Code 29824 is billable. It does not hit an edit. But 29826 for the SAD does. So you could bill out 23412, 29823, 29824. Code 29822 still hits an edit with these codes because limited debridement is included with any shoulder procedure.