Cost of Reverse Shoulder Replacement Surgery. The average cost of total reverse shoulder replacement surgery is 6,500$ to 20,000$, and those with health insurance will pay less. Conclusion. Reverse shoulder replacement has improved the management of shoulder diseases for which there was previously no simple or satisfactory cure.
What is Reverse Total Shoulder Replacement? Reverse total shoulder replacement is a surgical procedure that replaces the shoulder’s ball and socket in the opposite location than the original anatomy of the shoulder joint. In a reverse total shoulder replacement, the ball is inserted where the socket had been located and the socket is inserted ...
What to expect directly after surgery:
Reverse Shoulder Replacement: 5 Things You Can Expect
Total Shoulder Arthroplasty (TSA, including Reverse TSA) is billed as CPT code 23472; Shoulder Hemi-arthroplasty is CPT code 23470; Revision Shoulder Arthroplasty (one component- ball or socket revision) is CPT code 23473; Revision Shoulder Arthroplasty (both ball and socket) is CPT code 23474.
A reverse total shoulder replacement is a special type of shoulder surgery. During the surgery, your surgeon removes the damaged parts of the shoulder and replaces them with artificial parts. The shoulder joint is made up of the upper arm bone (humerus) and the shoulder blade (scapula).
The major difference between a standard shoulder replacement and a reverse procedure is that in a reverse shoulder replacement the ball and socket parts of the shoulder joint switch sides. This means their natural position is reversed.
In a reverse shoulder replacement, the normal ball-and-socket structure is reversed. An artificial ball is attached to the shoulder blade. An artificial socket is attached to the top of the arm bone. The large deltoid muscle that covers the shoulder is typically able to move the arm.
The type of anesthesia a patient will receive is decided well ahead of the surgery. Beginning at the front, top of the shoulder, the surgeon makes an curved incision about 6 inches long. The surgeon then cuts through deeper tissue, including one of the rotator cuff tendons, to access the shoulder joint.
Presence of left artificial shoulder joint Z96. 612 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM Z96. 612 became effective on October 1, 2021.
As the somewhat confusing name implies, reverse total shoulder replacement surgery involves a reversal in the process. In traditional total shoulder replacement the procedure involves replacing the ball and socket of the shoulder joint. Reverse total shoulder replacement also replaces this ball and socket.
For patients with large rotator cuff tears or shoulder arthritis, arthropathy, reverse total shoulder replacement is a better option because the rotator cuff muscles no longer function. The reverse total shoulder replacement relies on the deltoid muscle, instead of the rotator cuff, to position and power the arm.
A reverse total shoulder replacement works better for people with cuff tear arthropathy because it relies on different muscles to move the arm. In a healthy shoulder, the rotator cuff muscles help position and power the arm during range of motion.
Revision to reverse shoulder arthroplasty is an option in the treatment of failed anatomic prostheses. The reverse prosthesis is designed to compensate for an insufficient rotator cuff by recruiting anterior and posterior fibers of the deltoid muscle. Restoration of deltoid tension results in lengthening of the arm.
An orthopedic surgeon will replace the natural bone in the ball and socket of your shoulder joint with a material that could be metal or plastic. It's a major surgery that'll keep you in the hospital for several days. You'll also need several weeks of physical therapy afterward.
The reverse total shoulder replacement relies on the deltoid muscle, instead of the rotator cuff, to power and position the arm. This surgery was originally designed in the 1980s in Europe.
Reverse total shoulder replacement is an alternative procedure for patients whose shoulder disorder cannot be effectively managed with a conventional total shoulder replacement. As indicated by its name, the ball and socket implants go in opposite locations. In a reverse total shoulder replacement, the ball is placed on the glenoid and the socket is placed on top of the humerus. Five or more implants are typically used. A baseplate is screwed into the glenoid and a metallic ball is then attached to the baseplate. On the other side, a metallic stem and neck are implanted into the humerus to which the cup is then attached. A spacer may also be used in the humerus. This spacer acts as a permanent implant to achieve proper joint tensioning.
The “reverse shoulder” procedure includes the repair of the rotator cuff, tenodesis and the latissimus dorsi transfer. The code assignment includes all the work done to complete the replacement and achieve the functionality of the joint replaced. Assign ICD-10-PCS code as follows:
BCBS of IL (HCSC) medical policy for reverse shoulder arthoplasty (medical policy SUR705.031) states to bill C PT code 23929, ICD-9 codes 716.11, 996.40-996.49, and ICD-9 procedure code 81.80.
A. CPT will, at times, have one code that covers a particular procedure such as arthroplasty. Different techniques are then developed to either enhance or strengthen the procedure. But when it comes to coding, the procedure is still considered an arthroplasty.