2021 ASC Coding Tips: Distal Claviculectomy Coding
By Mandeara Frye, RHIA, CPC, CPMA, CASCC, Director of Coding
Over the last 10-15 years, there has been significant debate regarding the requirements for distal claviculectomy coding. While the American Medical Association has never taken an official stance on the matter, the American Academy of Orthopaedic Surgeons previously recommended that at least 8-10 mm of bone be removed to support coding. When this guidance was removed from the organization's Global Data Guide, many surgeons stopped documenting the amount of excision in their operative reports.
CMS has approved a RAC audit initiative targeting these procedures. Under this audit, the agency is specifying that 8-10 mm of bone must be removed to support coding either the open or arthroscopic distal clavicle excisions.
The affected codes are as follows:
- 23120 — Claviculectomy; partial
- 29824 — Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure)
We strongly encourage all physicians to specify the length of bone removed in their documentation as a best practice. For clients who use Surgical Notes for coding, our team will be querying physicians when this information is not included in the operative report. Documenting this in the initial report will help minimize the number of queries being sent and will accelerate claims processing and reimbursement.Information on this RAC topic can be found on the CMS website here.