Rotator Cuff Coding Reference Guide - Hip | Knee | Shoulder
[Pages:1]Rotator Cuff Coding Reference Guide
Physician CPT? Code 23410 23412 23420 29827
CPT Description Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; acute Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; chronic Reconstruction of complete shoulder (rotator) cuff avulsion, chronic (includes acromioplasty) Arthroscopy, shoulder, surgical; with rotator cuff repair
Hospital Outpatient and Free-Standing Ambulatory Surgery Center (ASC)
CPT Code CPT Description
23410 23412 23420
Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; acute
Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; chronic
Reconstruction of complete shoulder (rotator) cuff avulsion, chronic (includes acromioplasty)
29827
Arthroscopy, shoulder, surgical; with rotator cuff repair
OPPS ? Outpatient Prospective Payment System; APC ? Ambulatory Payment Classification Status Indicator J1 ? Hospital Part B services paid through a comprehensive APC APC 5114 ? Level 4 Musculoskeletal Procedures Payment Indicator A2 ? Payment based on OPPS relative payment weight.
OPPS Status Indicator
APC
J1
5114
J1
5114
J1
5114
J1
5114
ASC Payment Indicator A2
A2
A2 A2
Hospital Inpatient
MS-DRG and Description*
510 Shoulder, Elbow or Forearm Procedure, Except Major Joint Procedure with MCC 511 Shoulder, Elbow or Forearm Procedure, Except Major Joint Procedure with CC 512 Shoulder, Elbow or Forearm Procedure, Except Major Joint Procedure without CC/MCC
CC ? Complication and/or Comorbidity, MCC ? Major Complication and/or Comorbidity *MS-DRG ? Medicare Severity Diagnosis Related Group. Other MS-DRGs may apply
ICD-10-PCS Codes ?LQ1?ZZ ?LQ14ZZ ?LQ2?ZZ ?LQ24ZZ
ICD-10-PCS Description Repair Right Shoulder Tendon, Open Approach Repair Right Shoulder Tendon, Percutaneous Endoscopic Approach Repair Left Shoulder Tendon, Open Approach Repair Left Shoulder Tendon, Percutaneous Endoscopic Approach
HCPCS
HCPCS Code HCPCS Description
C1763
Connective tissue, non-human (includes synthetic)
HCPCS ? Healthcare Common Procedure Coding System Note: C-codes report devices used in conjunction with outpatient procedures billed and paid for under Medicare OPPS
For further assistance with coding and reimbursement questions, contact the Zimmer Biomet Reimbursement Hotline at 866-946-0444 or reimbursement@
Current Procedural Terminology (CPT ?) copyright 2016 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
Zimmer Biomet 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. 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 Biomet 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 provider's
respective Medicare Administrative Contractor, or to appropriate payers. Zimmer Biomet specifically disclaims liability or responsibility for the results or consequences of any actions taken in
reliance on information in this guide.
0871.2-US-en-REV1216
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