decisionhealth Newsletters, Part B News - 2015 Issue 9 (September)
Reverse shoulder arthroplasty doesn’t automatically use modifier 22
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Article Overview
This article explains a coding question involving reverse total shoulder arthroplasty in an orthopedic setting. It summarizes guidance referenced from an orthopedic society source and discusses how the procedure is categorized for reporting purposes, along with the general circumstances under which additional service reporting may be considered. The piece is aimed at coders and billing staff who work with shoulder surgery documentation and CPT reporting.
Why This Topic Matters
Orthopedic coding for shoulder arthroplasty can be misunderstood when technique changes the anatomy but not necessarily the underlying procedure family. This article helps readers distinguish between routine reporting questions and situations where additional service reporting may be supported by documentation.
What You Will Learn
- How reverse total shoulder arthroplasty is discussed in relation to standard shoulder arthroplasty reporting
- Why an unlisted procedure code may come up in coder discussions
- What types of documentation are generally associated with considering additional service reporting
- How an orthopedic society resource is used to support the discussion
Who Should Read This
- Orthopedic coders
- Medical billers
- Revenue cycle staff
- CPT coding professionals
Codes Discussed
Modifiers Discussed
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