Shoulder ICD-9 and CPT codes you’ll most likely see in the orthopedic ASC setting — explained.
If you’re an orthopedic coder, you don’t have to shoulder your shoulder coding burdens alone. We’ve rounded up a handy reference list of shoulder problems (along with sample procedures that fix them) that you’ll come across in an ambulatory surgical center setting.
AC Joint Separation
A separation of the acromioclavicular (AC) joint (831.04, Dislocation of shoulder; acromioclavicular [joint]), also called a “shoulder separation,” occurs when the clavicle and acromion separate due to a strain, sprain or tear of one or more shoulder ligaments. In the most serious form of AC joint separation, both the acromioclavicular ligament and the coracoclavicular ligament are completely torn. These injuries often occur following a fall or a direct blow to the shoulder, often during sports, and can cause intense shoulder pain.
If the injury is a grade 1 separation (a sprain without ligament tearing) or a grade 2 separation (with partial ligament tearing), surgeons usually prescribe pain medication and stabilize the joint using a sling. If the patient suffers a grade 3 separation with tearing of both ligaments and does not respond well to conservative treatment, the surgeon may opt to perform an AC joint stabilization surgery, also known as a Weaver-Dunn reconstruction (23550 or 23552).
Adhesive Capsulitis (Frozen Shoulder)
When thick bands of tissue (adhesions) grow around the shoulder joint, patients suffer from adhesive capsulitis (726.0, Adhesive capsulitis of shoulder). The condition is also known as “frozen shoulder” because the associated lack of synovial fluid prevents the shoulder from moving properly.
Physicians usually have success treating this condition with conservative treatment such as cortisone injections, physical therapy and nonsteroidal anti-inflammatory drugs (NSAIDs), but some patients still require surgery. Surgeons can sometimes treat adhesive capsulitis using manipulation under anesthesia (23700, Manipulation under anesthesia, shoulder joint, including application of fixation apparatus [dislocation excluded]). But some patients’ conditions are so severe that they require an arthroscopic release of adhesions (29825, Arthroscopy, shoulder, surgical; with lysis and resection of adhesions, with or without manipulation).
Bursitis/Tendonitis/Impingement Syndrome
Shoulder impingement syndrome (726.2, also known as “rotator cuff impingement”) occurs when a shoulder tendon or bursa is compressed or pinched. Bursitis and tendonitis are related to shoulder impingement syndrome and can occur together. Impingement is common in athletes who perform activities that involve frequent reaching over the head, such as swimming or playing tennis.
If a patient suffers from tendonitis of the shoulder, his or her rotator cuff (726.10) and/or biceps tendon (726.12) become inflamed, resulting in pain and swelling. Many patients, particularly athletes, suffer from overuse tendonitis. This means that the tendons are irritated, bruised or frayed due to repetitive shoulder motions during sports, frequent lifting or other overhead activities.
Other patients experience calcific tendonitis (726.11), which means that calcium deposits have accumulated in the shoulder tendons, leading to pain and loss of motion.
Shoulder bursitis (726.10) occurs when the bursa (a fluid-filled sac) in the rotator cuff becomes inflamed. This can cause swelling, redness, pain and loss of motion. Bursitis can lead to impingement because the swelling and inflammation can cause the tendons and bursa to become pinched between the bones.
If conservative treatments fail, the surgeon may perform subacromial decompression with anterior acromioplasty (29826, 23130, or 23415).
Rotator Cuff Tear
The rotator cuff is a group of four muscles that work together and help stabilize the shoulder. The muscles are the subscapularis, supraspinatus, infraspinatus and teres minor. Patients can suffer acute or chronic tears of the rotator cuff, and both types of rotator cuff tears (727.61 or 840.4) have their own special treatment options and recovery periods.
Acute rotator cuff tear: Acute tears usually happen suddenly as a result of a fall or a sudden jerking movement (such as throwing a football very hard). This will cause sudden pain and weakness, and possibly a “snapping” feeling.
Chronic rotator cuff tear: Chronic tears usually exhibit symptoms over time, going from mild pain to severe pain and inability to lift the arm above the head. These tears can be a result of overuse or wear and tear.
Although some rotator cuff tears can be managed with physical therapy, rest and stabilization, more severe tears may require surgical rotator cuff repair (23410, 23412, 23420 for open procedures). In some cases, the surgeon may choose to perform the repair arthroscopically (29827).
Shoulder Instability/Recurrent Dislocation
Shoulder instability (also known as “loose shoulder”) is caused by a subluxation (partial dislocation) that causes the ball of the shoulder joint to become unstable anteriorly because the ligaments and muscles are overstretched. The surgeon will probably perform an x-ray or magnetic resonance imaging (MRI) to confirm a shoulder instability (718.81) diagnosis.
If the patient’s shoulder does not heal or if the patient suffers a recurrent shoulder dislocation (718.31), the surgeon may choose to perform surgery, such as a capsulorrhaphy (23450, 23466) or arthroscopic capsulorrhaphy (29806).
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