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The procedure described by CPT® Code 23145 involves the excision or curettage of a bone cyst or benign tumor located in the clavicle or scapula, accompanied by the use of an autograft. A bone cyst is defined as a fluid-filled cavity within the bone, which can vary in type. The unicameral or simple bone cyst is a common benign lesion, while the aneurysmal bone cyst is characterized by vascular tissue surrounding a blood-filled cystic lesion. Additionally, benign bone tumors can include various forms such as giant cell tumors, chondromyxoid fibromas, and enchondromas. The procedure begins with an incision over the lesion site, followed by dissection of the soft tissues to expose the lesion. If a cystic lesion is identified, the bone is incised to create a window, allowing for the aspiration of fluid for laboratory analysis. The lining of the cystic cavity is then removed through curettage. In cases of benign tumors, the lesion is excised along with a margin of healthy bone. Following the excision or curettage, the procedure includes obtaining a healthy bone graft, either from the local area or a separate site, such as the iliac crest, which is then packed into the defect created in the proximal humerus. This comprehensive approach ensures the effective removal of the lesion while promoting healing through the use of the autograft.
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The procedure described by CPT® Code 23145 is indicated for the treatment of specific conditions affecting the clavicle or scapula, particularly:
The procedure involves several critical steps to ensure the effective removal of the lesion and the successful application of an autograft:
Post-procedure care involves monitoring the surgical site for signs of infection and ensuring proper healing of the incision. Patients may be advised on activity restrictions to allow for adequate recovery. Follow-up appointments are typically scheduled to assess the healing process and the integration of the autograft. Rehabilitation may be necessary to restore function and strength in the affected area, depending on the extent of the procedure and the patient's overall health.
| Short Descr | REMOVAL OF BONE LESION | Medium Descr | EXC/CURTG BONE CST/B9 TUM CLAV/SCAPULA W/AGRFT | Long Descr | Excision or curettage of bone cyst or benign tumor of clavicle or scapula; with autograft (includes obtaining graft) | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P3D - Major procedure, orthopedic - other | MUE | 1 | CCS Clinical Classification | 142 - Partial excision bone |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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