Coding Arthroscopy Shoulder Procedures


CPT codes for arthroscopy shoulder procedures are few — 13 to be exact. Arthroscopy shoulder procedures generally are done for a pathology that affects the shoulder muscles, such as rotator cuff tear, superior glenoid labrum (SLAP) lesions, or other acute or chronic injuries.

The coder must be aware of the following when coding for shoulder procedures:

» The surgeon can perform several procedures via the scope at one operative session. All of the procedures that are performed should be coded, with the exception of those procedures that CPT and/or the National Correct Coding Initiatives (NCCI) identify as “separate procedures.” Only those separate procedures that meet the definition of separate and distinct may be coded with a comprehensive procedure. In these cases modifier 59, distinct procedural service, may be appended to the appropriate separate procedure code.

» It is not how a procedure begins, but how it finishes that determines proper coding. Due to previous surgeries or injuries to the shoulder, the anatomy can sometimes become distorted and the surgeon may need to convert the arthroscopy to an open procedure.

• If the procedure began as an arthroscopy and the surgeon decides to proceed with an open procedure, the NCCI states that only the open procedure will be assigned. There will be no code for the exploratory arthroscopy.

• Code all the therapeutic procedures that were done via arthroscopy and append the best modifier to explain the scenario: In some cases this will be modifier 59.

• Separately code all open procedures performed.

• Do not code the open or the closing.

As noted above, the coder should be familiar with the “Separate Procedure” rule.

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