Orthopedic Coding: Shoulder Claim Success? Here's How

By Author: Angela Martin
Total Articles: 205
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In order to report shoulder procedures, you need to know what to report and when to report. Even if you are to stay out of auditors' cross hairs, you should remember what not to report. You need to have a comprehensive knowledge of shoulder anatomy as you more readily know what your orthopedist is up to. What's more, being well-versed with the anatomy will provide you a sound understanding of when you should claim open procedures.


Arthroscopy plus arthrotomy? Go for 1 code


Scenario: A 20-year-old male dislocated his right shoulder when playing football with friends. The provider reduced it in the ED and sent the patient to physical therapy; however the patient feels his shoulder is still not stable.


The orthopedist carries out a physical exam which demonstrates a positive anterior apprehension sign and the patient has a normal neurological examination. X-rays of the shoulder are negative, however magnetic resonance imaging (MRI) shows a large Bankart lesion.


Arthroscopic evaluation shows a large Bankart lesion with a major Hill-Sachs lesion. The orthopedic ...
... surgeon converts to an open procedure and carries out an arthrotomy. He repairs the glenoid labrum; however the shoulder remains unstable; as such he places a bony block anteriorly to further stabilize the shoulder. After this the surgeon closes the wound and places the patient in a shoulder immobilizer.


Watch out: Many doctors want medical coders to use 29805 in addition to an arthrotomy code. This is not ok. Instead, you should use the open code alone, even if the doctor did an arthroscopic exam prior to opening.


For more sure-success strategies for coding shoulder procedure and other orthopedic coding tips, sign up for an audio conference. Onboard such a conference, you can get CD or transcript of presentations close to this topic. The best part is you even stand to acquire CEUs on attending these audio conferences.