Coding Guidance for Rotator Cuff Surgical Repair - …

1 PHYSICIAN Coding CPT Codes1 CPT Description23410 Repair of ruptured musculotendinous cuff (eg, Rotator cuff ) open; acute23412 Repair of ruptured musculotendinous cuff (eg, Rotator cuff ) open; chronic23420 Reconstruction of complete shoulder ( Rotator ) cuff avulsion, chronic (includes acromioplasty)29287 Arthroscopy, shoulder, Surgical ; with Rotator cuff repairOUTPATIENT HOSPITAL and FREESTANDING ASCCPT CodesCPT DescriptionOPPS Status IndicatorAPC GroupAmbulatory Surgery Center Payment Indicator23410 Repair of ruptured musculotendinous cuff (eg, Rotator cuff ) open; acute T 0051 A223412 Repair of ruptured musculotendinous cuff (eg, Rotator cuff ) open; chronic T 0051 A223420 Reconstruction of complete shoulder ( Rotator ) cuff avulsion, chronic (includes acromioplasty) T 0051 A229287 Arthroscopy, shoulder, Surgical .

2 With Rotator cuff Repair T 0042 A2 Status indicators (T) Multiple procedure reductions indicators (A2) Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight; (J8) Device-intensive procedure; paid at adjusted cuff Repair Surgical PROCEDURES Coding REFERENCE GUIDEHOSPITAL PROCEDURE Coding ICD-9 CodesICD-9 Description of recurrent dislocation of shoulder cuff repairHCPCS CODE HCPCS CodeHCPCS Description C1763 Connective tissue, nonhuman (includes synthetic)

3 HOSPITAL INPATIENT MS-DRGMS-DRG Description 510 Shoulder, Elbow or Forearm Procedure, Except Major Joint Procedure with MCC511 Shoulder, Elbow or Forearm Procedure, Except Major Joint Procedure with CC512 Shoulder, Elbow or Forearm Procedure, Except Major Joint Procedure without CC/MCCCC Complications and/or comorbidities, MCC Major Complications and/or comorbidities1 Current Procedural Terminology (CPT ) copyright 2011 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical cuff Repair Clinical Documentation GuidelinesSupporting Documentation:History and Physical: A full history and physical should be obtained from the referring physician detailing the signs, symptoms and conditions that deem the Rotator cuff Repair necessary.

4 The physician should be aware of all medications the patient may be Work-up: Routine x-ray, Arthrogram, and/or MRI Final Note/Summary: The final note should indicate the procedure(s) performed, and the final pathology findings, if any. Follow up and treatment options should also be Therapies:Prior to Surgical Repair of the Rotator cuff , conservative management should be followed. This may include rest, the use of non-steroidal anti-inflammatory drugs, exercise to stretch and strengthen the joint, and/or corticosteroid injection to reduce / Associated Pathology.

5 Shoulder pain when raising arm over the head Weakness Bone spur Inflammation around the Rotator cuff Chronic impingement syndromeZimmer Coding Reference Guide Disclaimer The information in this document was obtained from third party sources and is subject to change without notice, including as a result in changes in reimbursement laws, regulations, rules and policies. All content in this document is informational only, general in nature and does not cover all situations or all payers rules or policies. The service and the product must be reasonable and necessary for the care of the patient to support reimbursement.

6 Providers should report the procedure and related codes that most accurately describe the patients medical condition, procedures performed and the products used. This document represents no promise or guarantee by Zimmer regarding coverage or payment for products or procedures by Medicare or other payers. Providers should check Medicare bulletins, manuals, program memoranda, and Medicare guidelines to ensure compliance with Medicare requirements. Inquiries can be directed to the hospital s Medicare Part A fiscal intermediary, the physician s Medicare Part B carrier, or to appropriate payers.

7 Zimmer specifically disclaims liability or responsibility for the results or consequences of any actions taken in reliance on information in this further assistance with Coding questions, contact the Zimmer Reimbursement Hotline at 866-946-0444.