THE CODING EDGE® ARCHIVES

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Procedure Practice 02/15/99 - Feature Article 02/15/99
   

Procedure Practice 02/15/99:
Coding Recommendations

  
Listed below are the ICD-9-CM diagnosis and procedure codes as well as the CPT-4 procedure codes that we think properly classify the treatment described. Please note that modifiers, used only for physician billing purposes, have not been assigned to the CPT-4 codes. If you disagree with our suggestions or have other comments, please send an e-mail to codingedge@lagunamedsys.com.
   

Suggested Codes and Rationale
   

Diagnosis Codes

The physician states that the patient has right shoulder AC joint arthrosis and osteoarthritis. The physician further states that no other joints show signs of arthrosis. The terms "arthrosis" and "osteoarthrosis" are interchangeable. The index entry for arthrosis appears as follows:

Arthrosis (deformans) (degenerative) (see also Osteoarthrosis) 715.9

The heading for category 715 in the Tabular List is "Osteoarthrosis and allied disorders." If we look at code 715.9, Osteoarthrosis, unspecified whether generalized or localized, we see that we need to be more specific in order to identify involvement of only one joint ("localized"). Looking at the other 715 subheadings, the most appropriate code is 715.31, Osteoarthrosis, localized, not specific whether primary or secondary, shoulder region.
  

ICD-9-CM Procedure Codes

The surgeon performed an arthroscopic labral debridement and a "mini-open" partial claviculectomy. Since the arthroscopy was the surgical approach, it is not coded separately from the labral debridement. The entry for "Debridement, joint" in the Procedure Index refers us to "Excision, lesion, joint" which then lists a subheading for shoulder with the code 80.81. Turning to the Tabular List, we see that 80.81, Other local excision or destruction of lesion of joint, correctly identifies the arthroscopic portion of the procedure.

Turning back to the Index to Procedures, find "Claviculectomy (partial), 77.81." A close look at the exclusion note for 77.81 reveals that excision of bone ends associated with arthroplasty is excluded from this code. So, turning back to the Index, let's find "Arthroplasty, shoulder" which directs us to 80.83. The description of 80.83, Other repair of shoulder, although very general, is the best code selection to identify the AC joint repair.
  

CPT-4 Procedure Codes

The index entry for "Shoulder, arthroscopy, surgical" directs us to codes 29819-29826.

The surgeon performed extensive superior and posterior labral debridement. The correct code for this procedure is 29823, Arthroscopy, shoulder, surgical; with debridement, extensive. Returning to the Index, the entry for "Clavicle, excision, partial" lists two possible codes, 23120 and 23180. The descriptions of these codes indicate that the correct selection is 23120, Claviculectomy, partial.

   

Procedure Practice 02/15/99 - Feature Article 02/15/99

Bibliography - References:
1999 Coders Desk Reference, Medicode, Salt Lake City, UT
Current Procedural Terminology CPT 1999, American Medical Association, Chicago, IL
St. Anthony's Illustrated ICD-9-CM Code Book, St. Anthony Publishing, Reston, VA		 Notice: This part of our web site was prepared to assist in understanding and maintaining good coding skills. For proper use of this feature, reference must be made to official coding guidelines when necessary. The information here presented is only to be used as a supplement to those guidelines. Laguna Medical Systems, Inc., makes no representations or guarantees as to amounts that will be paid by Medicare or other third party payers.

 

Please be aware that the Coding Edge® Archive pages are NOT retroactively updated
to reflect possible coding rules and regulation changes made after the publishing date.