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Bankart Lesion: How do Code?

Image result for bankart lesionA Bankart lesion is an injury of the anterior (inferior) glenoid labrum of the shoulder due to anterior shoulder dislocation. When this happens, a pocket at the front of the glenoid forms that allows the humeral head to dislocate into it.

The Bankart lesion is an injury of the glenohumeral joint. This is a ball-and-socket joint binds the scapular and the humerus. Parts of the joint are the labrum, a fibrocartilaginous structure around the glenoid, the capsule and ligaments and supporting muscle tendons.

Patients with a Bankart lesion are recognised by shoulder pain which is not localized in a specific point and the pain gets worse when the arm is held behind the back. They also feel weakness and instability of the shoulder. 

ICD-9 code designated for a Bankart lesion

CMS has not instituted an ICD-9 code for a Bankart lesion. Bankart lesions usually result from a traumatic shoulder dislocation, so we would use the dislocation code to identify the patient’s original problem.

For an acute injury, report the shoulder dislocation code, 831.0x. If the Bankart lesions appear following a chronic problem, recurrent dislocations (718.31) or shoulder instability (718.81) is usually the cause.

Bankart ICD-10

CPT codes

  • 23455 – Capsulorrhaphy, anterior; with labral repair (Bankart procedure). There are parenthetical notes under this CPT code that instruct a coder to report 29806 for the arthroscopic procedure.
  • 29806 – Arthroscopy, shoulder, surgical; capsulorrhaphy

According to CPT 2004, surgeons who perform Bankart procedures through the scope to report 29806 (Arthroscopy, shoulder, surgical; capsulorrhaphy).

According to AMA , 29807 (Arthroscopy, shoulder, surgical; repair of SLAP lesion) can be used, a new parenthetical note following the open Bankart code (23455, Capsulorrhaphy, anterior; with labral repair e.g., Bankart procedure) directs coders to use 29806 for the arthroscopic version of this shoulder repair.

Because the RVUs for 29806 are higher than for 29807 (27.54 vs. 26.77), will allow orthopedic surgeons to collect more reimbursement for Bankart procedures than in the past.

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