Reimbursement
CPT Codes for Select Procedures for Physician, Hospital Outpatient and ASC Settings
CPT Code Descriptor
Select Tendon Repair Procedures of the Shoulder, Including the Rotator Cuff
23405 Tenotomy, shoulder area; single tendon
23406 Tenotomy, shoulder area; multiple tendons through same incision
23410 Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; acute
23412 Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; chronic
23415 Coracoacromial ligament release, with or without acromioplasty
23420 Reconstruction of complete shoulder (rotator) cuff avulsion, chronic (includes acromioplasty)
29826 Arthroscopy, shoulder, decompression of subacromial space with partial acromioplasty, with or without coracoacromial release
29827 Arthroscopy, shoulder, surgical; with rotator cuff repair
23929 Unlisted procedure, shoulder
29999 Unlisted procedure, arthroscopy
Select Tendon Repair Procedures Involving the Knee, Including Patellar Tendon
27380 Suture of infrapatellar tendon; primary
27381 Suture of infrapatellar tendon; secondary reconstruction, including fascial or tendon graft
27385 Suture of quadriceps or hamstring muscle rupture; primary
27386 Suture of quadriceps or hamstring muscle rupture; secondary reconstruction, including fascial or tendon graft
27599 Unlisted procedure, femur or knee
Select Tendon Repair Procedures of the Ankle, Including the Achilles Tendon
27605 Tenotomy, percutaneous, Achilles tendon (separate procedure); local anesthesia
27606 Incision of Achilles tendon
27650 Repair, primary, open or percutaneous, ruptured Achilles tendon
27652 Repair, primary, open or percutaneous, ruptured Achilles tendon; with graft (includes obtaining graft)
27654 Repair, secondary, Achilles tendon, with or without graft
27675 Repair, dislocating peroneal tendons; without fibular osteotomy
27685 Lengthening or shortening of tendon, leg or ankle; single tendon, (separate procedure)
27686 Lengthening or shortening of tendon, leg or ankle; multiple tendons (through same incision), each
27899 Unlisted procedure, leg or ankle

Current Procedure Terminology (CPT) is a registered trademark of the American Medical Association (AMA). Copyright 2009 AMA. All rights reserved.

Federal Register, Vol.73:224 dated November 19, 2008 and Federal Register, Vol.73:223 dated November 18, 2008. Actual payment rates will vary based on geographical adjustments to payments. Medicare payment rates effective January 1 through December 31, 2009.

2009 Selected MS-DRGs
MS-DRG Descriptor
488 Knee procedures w/o pdx of infection w CC/MCC
489 Knee procedures w/o pdx of infection w/o CC/MCC
500 Soft tissue procedures w MCC
501 Soft tissue procedures w CC
502 Soft tissue procedures w/o CC/MCC
507 Major shoulder or elbow joint procedures w CC/MCC
508 Major shoulder or elbow joint procedures w/o CC/MCC
509 Arthroscopy
510 Shoulder, elbow or forearm proc, exc major joint proc w MCC
511 Shoulder, elbow or forearm proc, exc major joint proc w CC
512 Shoulder, elbow or forearm proc, exc major joint proc w/o CC/MCC
907 Other O.R. procedures for injuries w MCC
908 Other O.R. procedures for injuries w CC
909 Other O.R. procedures for injuries w/o CC/MCC
984 Prostatic O.R. procedure unrelated to principal diagnosis w MCC
985 Prostatic O.R. procedure unrelated to principal diagnosis w CC
986 Prostatic O.R. procedure unrelated to principal diagnosis w/o CC/MCC
Possible ICD-9-Procedure Codes
81.44 Patellar stabilization
83.13 Other tenotomy
83.61 Suture of tendon sheath
83.62 Delayed suture tendon
83.63 Rotator cuff repair
83.64 Other suture of tendon
83.73 Reattachment of tendon
83.81 Tendon graft
83.88 Other plastic operations on tendon

Federal Register, Vol.73:121 dated October 3, 2008. Actual payment rates will vary based on geographical adjustments of payments. National average (wage index greater than one) MS-DRG rates calculated using the national adjusted full update standardized labor, non-labor and capital amounts ($5,552.58). Hospital in patient payment rates effective October 1, 2008 through September 30, 2009.

This information does not constitute reimbursement or legal advice. Synthasome makes no representation or warranty regarding this information or its completeness, accuracy or timeliness. As with all claims, individual physicians and facilities are responsible for exercising their independent clinical judgment in selecting the codes that most accurately reflect the patient’s condition and procedures performed or provided to a patient. Providers should refer to current, complete and authoritative publications such as AMACPT or insurer policies for selecting codes based on the care rendered to an individual patient and may wish to contact individual carriers or other third-party payers as needed.