SHOULDER ARTHROPLASTY SURGICAL
PROCEDURES CODING REFERENCE GUIDE
PHYSICIAN CODING
CPT Codes 1
CPT Description
23331
Removal of foreign body, shoulder; deep (eg, Neer hemiarthroplasty removal)
23332
Removal of foreign body, shoulder; complicated (eg, total shoulder)
23470
Arthroplasty, glenohumeral joint; hemiarthroplasty
23472
Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement (eg, total shoulder))
23473
Revision of total shoulder arthroplasty, including allograft when performed; humeral or glenoid component
23474
Revision of total shoulder arthroplasty, including allograft when performed; humeral and glenoid component
23616
Open treatment of proximal humeral (surgical or anatomical neck) fracture, includes internal fixation, when performed, includes
repair of tuberosity(s), when performed; with proximal humeral prosthetic replacement
+20985
Computer-assisted surgical navigational procedure for musculoskeletal procedures, image-less (List separately in addition to
code for primary procedure)
+ add on code
OUTPATIENT HOSPITAL AND FREE-STANDING ASC
CPT Codes
CPT Description
OPPS Status
Indicator
APC Group
Ambulatory Surgery Center
Payment Indicator
23331
Removal of foreign body, shoulder; deep (eg, Neer hemiarthroplasty
removal)
0022
A2
23332
Removal of foreign body, shoulder; complicated (eg, total shoulder)
NA
C5
23470
Arthroplasty, glenohumeral joint; hemiarthroplasty
0425
IO
23472
Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal
humeral replacement (eg, total shoulder))
NA
C5
23473
Revision of total shoulder arthroplasty, including allograft when
performed; humeral or glenoid component
0425
IO
23474
Revision of total shoulder arthroplasty, including allograft when
performed; humeral and glenoid component
NA
C5
23616
Open treatment of proximal humeral (surgical or anatomical neck)
fracture, includes internal fixation, when performed, includes repair
of tuberosity(s), when performed; with proximal humeral prosthetic
replacement
0064
A2
+20985
Computer-assisted surgical navigational procedure for musculoskeletal
procedures, image-less (List separately in addition to code for primary
procedure)
NA
NI
Status indicators (T) Multiple procedure reductions apply; (C) Inpatient procedure; (N) Items and service packaged into APC rates
Payment indicators (A2) Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight; (C5) Inpatient Procedures; (IO) Surgical procedure not on ASC
allowable list; (NI) Packaged service/item; no separate payment made.
NA Medicare has not developed a rate for the In-Office setting as the procedure is typically performed in the hospital setting.
HCPCS CODE
HCPCS Code
C1776
HCPCS Description
Joint device (implantable)
C-codes report devices used in conjunction with outpatient procedures billed and paid for under Medicare HOPPS (outpatient procedures only)
(Shoulder Continued)
HOSPITAL PROCEDURE CODING
ICD-9 Codes
ICD-9 Description
79.21
Open reduction of fracture of humerus without internal fixation
79.31
Open reduction of fracture of humerus with internal fixation
80.01
Arthrotomy for removal of prosthesis without replacement, shoulder
81.80
Other total shoulder replacement
81.81
Partial shoulder replacement
81.88
Reverse total shoulder replacement
81.97
Revision of joint replacement of upper extremity
84.57
Removal of (cement) spacer
00.34
Imageless computer assisted surgery
HOSPITAL INPATIENT
MS-DRG
MS-DRG Description
483
Major Joint and Limb Reattachment Procedures of Upper Extremity with CC/MCC
484
Major Joint and Limb Reattachment Procedures of Upper Extremity without CC/MCC
492
Lower Extremity and Humerus Procedures Except Hip, Foot, Femur with MCC
493
Lower Extremity and Humerus Procedures Except Hip, Foot, Femur with CC
494
Lower Extremity and Humerus Procedures Except Hip, Foot, Femur without CC/MCC
495
Local Excision and Removal Internal Fixation Devices Except Hip and Femur with MCC
496
Local Excision and Removal Internal Fixation Devices Except Hip and Femur with CC
497
Local Excision and Removal Internal Fixation Devices Except Hip and Femur without CC/MCC
515
Other Musculoskeletal System and Connective Tissue O.R. Procedure with MCC
516
Other Musculoskeletal System and Connective Tissue O.R. Procedure with CC
517
Other Musculoskeletal System and Connective Tissue O.R. Procedure without CC/MCC
CC Complications and/or comorbidities, MCC Major Complications and/or comorbidities
1
Current Procedural Terminology (CPT ) copyright 2012 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
Zimmer Coding Reference Guide Disclaimer
The information in this document was obtained from third party sources and is subject to change without notice, including as a result in changes in reimbursement laws, regulations, rules and
policies. All content in this document is informational only, general in nature and does not cover all situations or all payers rules or policies. The service and the product must be reasonable
and necessary for the care of the patient to support reimbursement. Providers should report the procedure and related codes that most accurately describe the patients medical condition,
procedures performed and the products used. This document represents no promise or guarantee by Zimmer regarding coverage or payment for products or procedures by Medicare or other
payers. Providers should check Medicare bulletins, manuals, program memoranda, and Medicare guidelines to ensure compliance with Medicare requirements. Inquiries can be directed to
the hospitals Medicare Part A fiscal intermediary, the physicians Medicare Part B carrier, or to appropriate payers. Zimmer specifically disclaims liability or responsibility for the results or
consequences of any actions taken in reliance on information in this document.
For further assistance with coding questions, contact the Zimmer Reimbursement Hotline at 866-946-0444.
