Shoulder Arthroscopy (Rotator Cuff Repair)

What it is

The rotator cuff is a set of tendons that wrap the top of the arm bone and hold it centered in the shallow socket of the shoulder. When one tears away from its attachment, raising the arm becomes weak and painful, and the tendon does not reattach itself. Repair means bringing the torn edge back to its footprint on the bone and fixing it there with anchors and suture. This code is for doing that arthroscopically: the surgeon works through several small punctures, using a pencil-thin camera inside the joint and instruments passed through the others. Because the deltoid muscle does not have to be detached to get access, it is the least invasive of the ways to repair a cuff. Open and mini-open repairs are separate codes.

Why it is done

• To repair a torn rotator cuff tendon that has not responded to months of physical therapy, injections, and activity changes
• When weakness and loss of function, not just pain, are the problem
• For a recent, acute tear in an otherwise healthy shoulder
• In people whose work or sport depends on repeated overhead use of the arm

What to expect

Most arthroscopic repairs are day surgery — in and home without an overnight stay. What is long is not the operation but the recovery, because a tendon has to grow back onto bone and that cannot be rushed. A sling is worn for the first several weeks, during which a therapist moves the arm for you rather than you moving it yourself. Active strengthening starts later, and useful range and strength typically arrive somewhere around four to six months. Sleeping is often the hardest part of the early weeks. The result depends heavily on the size and age of the tear and on the quality of the tissue being repaired.

Questions worth asking

• How many suture anchors are expected? Implants are frequently billed as separate supply items and can be a large share of the total.
• If other work is done in the same sitting — releasing a tight capsule, shaving bone, trimming a labral tear — is each one billed as an additional code?
• Is a nerve block planned in addition to the anesthetic, and does that carry its own charge?
• How many weeks of physical therapy will be needed, at what visit cost, and how many visits per year does my plan allow?
• Is the surgery booked at a hospital or an ambulatory surgery center, and is the whole team — surgeon, assistant, anesthesia — in network at that site?