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.