FAQ for Shoulder/Elbow

  1. Problem: How to report arthroscopic acromioplasty, limited debridement in glenohumeral joint (e.g., cuff, labrum, biceps), followed by open rotator cuff repair when performed at the same session?

    Action: Code 23420 should be used when the procedure is performed open. An arthroscopic acromioplasty with a mini open cuff repair may be billed as 23412 plus 29826-59.

  2. Problem: How to report arthroscopic procedures when there is no arthroscopic code?

    Action: The unlisted arthroscopy code 29999 should be used, and an operative note should be attached along with a note stating what open code the procedure is similar to. Arthroscopic cuff repair is similar to 23410, 23412, or 23420; arthroscopic thermal capsulorrhaphy is similar to 23450, 23465, or 23466. In CPT 2002, new shoulder arthroscopy codes include: arthroscopic distal claviculectomy (29824), arthroscopic Bankart (29806), and arthroscopic repair of SLAP lesion (29807)

  3. Problem: How do I code for a shoulder arthotomy with a glenoid socket replacement?

    Action: If a shoulder hemiarthroplasty is already in place and you put in a glenoid component, you are still doing a hemiarthroplasty of the glenhumeral joint - the only difference is that you are doing it on the glenoid side and not on the more commonly done humeral side. This scenario should be coded as 23470 (arthroplasty, glenohumeral joint; hermiarthoplasty). It would be appropriate to add a -22 modifier since there has been previous surgery, altered surgical field, increased scarring, and difficulty with exposure since a humeral hemiarthroplasty is already present.

  4. Problem: How do I code for a revision of a total elbow arthroplasty?

    Action: Use 24363 (Arthroplasty, elbow; with distal humerus and proximal ulnar prosthetic replacement (eg, total elbow) with a -22 modifier. Refer to code 24160 (implant removal; elbow joint) for removal of the implant. (Updated 06/06/2011)

  5. Problem: What CPT code should be used to report core decompression of the shoulder?

    Action: Use 20225 (Biopsy, bone, trocar, or needle; deep (eg, vertebral body, femur).

  6. Problem: Q: How do I code for the right shoulder arhroscopic subacrominal decompression, open rotator cuff repair, open mumford sub scapularis tendon repair, repair of humeral avulsion of glenojumeral ligament lesion (HAGL lesion)?

    Action: Report codes 23412 (Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; chronic), 29826 (Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with or without coracoacromial release), 23120 (Claviculectomy; partial) and for the HAGL lesion use code 23929 (Unlisted procedure, shoulder) although it may be considered included.

  7. Problem: What code do I use for an arthroscopic bicep tenotomy?

    Action: Arthroscopic biceps tenotomy is considered part of the debridement. One should report CPT code 29822 or 29823 based on the extent of work. 

  8. Problem: CPT code 29826, arthroscopic decompression, changed from a stand-alone to an add-on code in 2012. This is a large procedure in shoulder scopes. If the arthroscopic decompression is the only procedure performed, add-on code 29826 cannot be reported as a stand-alone code. How should the shoulder scope procedure be coded?

    Action: After discussion among the members of the AAOS Coding, Coverage and Reimbursement Committee of the AAOS, the most appropriate codes to use are 29822 (limited debridement) or 29823 (extensive debridement) depending on the extent of the work involved.

    For a more detailed explanation regarding the use of these codes, refer to the following coding update from the AANA website.