march 2016

Shoulder Manipulation

We have had a number of discussions recently about joint manipulation and the terms “under anesthesia, requiring anesthesia and under/requiring general anesthesia”. For some CPT codes such as 23700 the code description reads “Manipulation under anesthesia” and if you reference CPT Assistant April 2005 it will tell you that the type of anesthesia should be general anesthesia.

However, there is a more recent CPT Assistant from December 2006 which states the following:

It should be noted that there are certain CPT code descriptors in the CPT codebook that include the phrases "with anesthesia" or "requiring anesthesia." These phrases indicate that the work involved in performing that procedure requires anesthesia, whether it is general anesthesia, regional anesthesia, or monitored anesthesia care. The appropriate anesthesia code is reported separately.

Moderate (conscious) sedation is not an anesthesia service.

Based on this information it would be appropriate to report the shoulder manipulation code 23700 when the service is performed using general anesthesia, MAC or a regional block such as an interscalene block. This method of reporting differs from reporting of CPT codes such as 27570 Manipulation of knee joint under general anesthesia or 27275 Manipulation hip joint requiring general anesthesia, wherein these two types of services must be performed with general anesthesia being administered.

Previously CMS had instructed that HCPCS device codes should not be reported for Device Intensive Procedures. Effective Jan. 1, 2016 CMS policy now dictates that at least one HCPCS device code should be reported with any procedure that is considered to be Device Intensive.

When a procedure is interrupted and the device is not placed then the procedure code should be appended with modifier 52, 73 or 74 as applicable and this will override the device edit. See the Medicare Claims Processing Manual, Chapter 4, Section 61.2 for additional information.

It is recommended that you confirm this policy with your Local Medicare Carrier.



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