Biceps resection

Can 23440 open biceps resection be reported separately when massive repair of rotator cuff (23420) is performed?

re: Biceps resection

CCI Validation Results:


Question: Are there any authoritative guidelines on when to use 23420?

Answer: The AMA's CPT® Assistant (October 2005) states that 23420 (Reconstruction of complete shoulder [rotator] cuff avulsion, chronic [includes acromioplasty]) "is intended to identify an old tear." This guidance simply states the descriptor's "chronic" requirement in a different way. Your surgeon should document that the problem is more than three months old for you to consider it chronic.

CPT® Assistant goes on to state, "This type of extreme tear usually requires rearrangement of the normal anatomy and sometimes grafting with either biological or nonbiological material for repair." Again the guidance is expanding on the descriptor's "reconstruction" and "complete" requirements. CPT® Assistant is authoritative because it is from the AMA, which publishes the CPT® codes.

In addition, the February 2002 CPT® Assistant advises using 23420 when orthopedists repair "all three major muscles/tendons of the shoulder cuff."

Although not authoritative, the American Academy of Orthopedic Surgeons' April 2004 Bulletin, Accurately Code Shoulder Procedures, states, "If there is significant retraction with a large tear, extensive releases and mobilization may be required, justifying the use of code 23420. If fascia or synthetic material is required, code 23420 is also appropriate."

CCI Validation Results:

Code 23440 is a column 2 code for 23420 , but a modifier is allowed in order to differentiate between the services provided.
*Use modifier with code 23440
CCI edit Rule:
Standards of medical / surgical practice


Note*: Always use modifier (if allowable) with column 2 code.

The current NCCI-associated modifiers are: E1, E2, E3, E4, FA, F1, F2, F3, F4, F5, F6, F7, F8, F9, LC, LD, LM, RC, RI, LT, RT, TA, T1, T2, T3, T4, T5, T6, T7, T8, T9, 24, 25, 27, 57, 58, 59, 78, 79, and 91. Read about modifiers for CPT® and HCPCS codes

Source: www.supercoder.com