While CPT provides a parenthetical statement under CPT 29827 (Arthroscopy, shoulder, surgical; with rotator cuff repair), when directing the CPT user to report 23412 for mini open rotator cuff repair we still need to determine the final code selection based on the procedural description and whether the condition is acute versus chronic.
Coding tip: CPT code verbiage in 23410-23420 is specific for an acute versus chronic condition within its verbiage.
Documentation tip: The operative documentation should provide whether the patient has an acute versus chronic condition. If no indication is provided within the clinical documentation, CPT code determination cannot be made without physician query. To assume acute versus chronic will impact your facility’s bottom line by roughly $150 for applicable Medicare accounts.
Cristina Bentin can be reached at cristina@ccmpro.com. Learn more about Coding Compliance Management.
The information provided should be utilized for educational purposes only. Please consult with your billing and coding expert. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.
