Basics of Rotator cuff CPT code CPT code 23410, 23412, 23420 and 29827
The rotator cuff is a group of muscles in the shoulder that allow a wide range of movement while maintaining the stability of the glenohumeral joint. The rotator cuff includes the following muscles:
- Subscapularis
- Infraspinatus
- Teres minor
- Supraspinatus
A helpful mnemonic to remember these muscles is “SITS“. Rotator cuff tears occur when tendons weaken and pull away from the bone. Acute rotator cuff tears are caused by trauma such as falls on an outstretched hand or throwing actions (e.g. baseball). Chronic tears are caused by long term overuse or stress such as repetitive use injuries or heavy lifting.
Indication for CPT code 23410, 23412, 23420 and 29827
- Complete rotator cuff tear or rupture
- Crushing injury of shoulder and upper arm
- Incomplete rotator cuff tear or rupture
- Post-traumatic osteoarthritis
- Spontaneous rupture of extensor tendons
- Sprain of rotator cuff capsule
- Traumatic arthropathy
Read also: Sample coded report for Rotator cuff repair CPT codes
When to use CPT code 23410 and 23412
The physician repairs a ruptured rotator cuff. A longitudinal incision is made along the anterior portion of the shoulder and the skin is reflected. The deltoid fibers and the underlying tissues are divided. The coracoacromial ligament is divided and the supraspinatus tendon is detached by a transverse incision along the greater tuberosity. The distal frayed edges of the tendon are removed. A trench is chiseled into the humeral bone along the level of the anatomical neck of the humerus.
The supraspinatus tendon flap is buried in it. The flap is fixed with sutures tied to the tendon and passed through holes drilled in the bone. The repair is completed with side-to-side sutures of the supraspinatus to the adjacent subscapularis and infraspinatus tendons. The incision is closed and a soft dressing is applied. Protected motion in a specific progression of exercises is followed. CPT code 23410 is reported if the repair is done for an acute rupture of the musculotendinous cuff and code 23412 if chronic.
A rotor cuff injury would be reported as ‘chronic’ if the injury was degenerative in nature. Otherwise, it could be coded as an acute injury. For example, report code 23410 for an open rotator cuff repair done on an initial injury that occurred 4 months prior in a motor vehicle accident. This would not be considered a chronic injury even though the injury has been present for multiple months. If the procedure is performed arthroscopically, there are no separate CPT codes to distinguish acute from chronic; report the repair with code 29827.
Read also: Sample coded report for shoulder Arthroplasty CPT code
Acute versus Chronic coding Guide for coders
When to use CPT code 23420
The most common approach to reconstruct a complete rotator cuff avulsion tear of the shoulder is an anterior approach through an incision over the acromioclavicular joint. If the infraspinatus is to be shifted, a second incision is made along the scapular spine posteriorly, detaching a portion of the posterior deltoid if necessary. The margins of the tear are freshened and a non-absorbable suture closes the longitudinal portion of the tear. A portion of the articular cartilage on the underside of the humeral head is removed. The raw edges of the torn tendon are brought into contact with raw bone and the ends of the sutures are passed through holes drilled through the greater tuberosity and tied over its lateral aspect. The physician performs an acromioplasty.
Acromioplasty involves the division of the acromioclavicular ligament followed by the use of a burr to cut away the under surface of the acromion. During acromionectomy, the distal portion of the acromion is removed. Once the reconstruction is complete, the incision is closed and the arm may be positioned in an abduction splint or pillow for protection.
23420 Reconstruction of complete shoulder (rotator) cuff avulsion, chronic (includes acromioplasty)
When to use CPT code 29827
The physician performs a surgical arthroscopy of the shoulder to repair a torn rotator cuff. The patient is positioned side-lying with the arm suspended. Small percutaneous poke hole incisions are made around the shoulder through which the arthroscopic instruments are inserted. A solution is pumped through one of these incisions to cleanse and expand the joint for better visualization. The physician first performs a diagnostic arthroscopic exam to assess the joint. A limited bursectomy may be performed with a subacromial decompression in which the undersurface of the anterolateral acromion is cleared of soft tissue, if necessary. A small percutaneous incision may be made laterally incorporating one of the portholes to facilitate the arthroscopic repair. The deltoid muscle is split from its acromion attachment about 5 cm and the tendon edge is debrided and mobilized.
A transverse bony trough 3 to 4 mm is made and tunnels are drilled through the bone trough to the lateral cortex of the greater tuberosity. The tendon edge is brought into the trough with permanent sutures and anchor sutures are placed. Sutures are placed into the bone and brought through the tendon. A hemostat is placed on the cuff to retract the tendon and take tension off the sutures. The anchor sutures are tied down, followed by the sutures to the bony trough. The free ends of the sutures are passed through the tunnels and tied over a bony bridge. The longitudinal portions of the tear are closed with absorbable suture and a range of motion check is done on the arm. The deltoid splits, subcutaneous tissue, and skin are closed with suture, band aid, or Steri-strip, and the arm is placed in a sling to maintain abduction.
29827 Arthroscopy, shoulder, surgical; with rotator cuff repair
If a surgeon performed a rotator cuff repair on two of the tendons (i.e., supraspinatus and infraspinatus) arthroscopically with a third tendon (i.e., subscapularis) repaired via an open approach with a separate incision, reporting of this scenario would be 29827. The two of the rotator cuff tendons were repaired arthroscopically, meaning the majority of the work. An open conversion was not immediate, and the third rotator cuff tendon required a separate incisional open approach to complete the tendon repair session. If the majority of the work was done via an arthroscopic approach, only 29827 would be reported.
