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| 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.