All codes
T512
T512 – T512
OHIP Other Code · Schedule of Benefits
When to Use
- Use T512 for the surgical repair of a complete or incomplete rotator cuff tear when performed as an open or arthroscopic procedure.
- Apply this code when the procedure involves the formal reattachment of the tendon to the humeral head, distinct from simple debridement (which would be billed under a different code).
- Use T512 when the clinical documentation confirms a full-thickness or significant partial-thickness tear requiring formal fixation, rather than a diagnostic arthroscopy.
Common Pitfalls
- Billing T512 in conjunction with diagnostic arthroscopy codes is considered double-dipping, as the diagnostic component is included in the global fee for the repair.
- Failure to document the specific size and location of the tear often leads to audit rejections, as the complexity of the repair must justify the use of T512 over lesser procedures.
- Billing T512 with an additional code for subacromial decompression or acromioplasty is often rejected as these are typically bundled into the primary rotator cuff repair fee.
Billing Tips
- Ensure the operative report explicitly details the fixation method used, such as suture anchors or transosseous tunnels, to support the T512 claim during a post-payment review.
- If a secondary procedure is performed on the same shoulder that is not integral to the rotator cuff repair, append the appropriate modifier to justify the additional service.
Provider Fee$1,201.50
Specialist Fee$1,201.50
Effective: February 1, 2011
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