Home | 1/10/2019 Issue | Article

Don’t skip billing the primary procedure to avoid CCI, maximize money

Effective Jan 10, 2019
Published Jan 14, 2019
Last Reviewed Jan 10, 2019
Question: The orthopedic surgeon performed a total shoulder arthroplasty to treat a fracture (code 23472) and in the same encounter, did an open treatment of a proximal humeral fracture (23615) and a biceps tenodesis (23430). Yet codes 23615 and 23430 are bundled as components of 23472 by National Correct Coding Initiative (CCI) edits.This is leading some at our practice to wonder whether it would be better to just submit the fracture reduction and tenodesis codes and skip billing for the arthrodesis. What is the correct response?

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