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The CPT® Code 23155 refers to the surgical procedure involving the excision or curettage of a bone cyst or benign tumor located in the proximal humerus, 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 the most common, characterized as a benign lesion. In contrast, an aneurysmal bone cyst is less common and consists of vascular tissue surrounding a blood-filled cystic lesion. Additionally, there are various types of benign bone tumors, including giant cell tumors, chondromyxoid fibromas, and enchondromas. The procedure begins with an incision made over the lesion site in the proximal humerus, 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, which is then sent for laboratory analysis. The lining of the cystic cavity is removed through curettage, or the benign tumor may be excised along with a margin of healthy bone. In the case of CPT® Code 23155, after the lesion is treated, the physician obtains healthy bone either from the same site or from a different location, such as the iliac crest, to use as an autograft. This graft is then packed into the defect created in the proximal humerus, facilitating healing and structural integrity of the bone.
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The procedure described by CPT® Code 23155 is indicated for the treatment of specific conditions affecting the proximal humerus, particularly:
The procedure involves several critical steps to ensure effective treatment of the bone cyst or benign tumor:
After the procedure, patients typically require monitoring for any signs of complications, such as infection or graft failure. Post-operative care may include pain management, physical therapy to restore function, and follow-up appointments to assess healing. The expected recovery time can vary based on the extent of the procedure and the individual patient's health status. It is essential for patients to adhere to their surgeon's post-operative instructions to ensure optimal recovery and outcomes.
| Short Descr | REMOVAL OF HUMERUS LESION | Medium Descr | EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/AGRFT | Long Descr | Excision or curettage of bone cyst or benign tumor of proximal humerus; 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). | 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. | 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) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | 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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| Pre-1990 | Added | Code added. |
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