Case2Code

Code deleted, see 23330, 23333

Official Description

Removal of foreign body, shoulder; complicated (eg, total shoulder)

Common Language Description

The procedure described by CPT® Code 23332 involves the removal of a complicated foreign body from the shoulder, specifically in cases where a total shoulder prosthesis is involved. This procedure is typically indicated when there is a need to extract a foreign object that has become problematic, such as an implanted device or a penetrating object resulting from trauma. The process begins with a skin incision made over the shoulder joint, allowing access to the underlying structures. The surgeon dissects through the soft tissues to expose and open the joint capsule, which is crucial for visualizing the components of the shoulder joint. During the procedure, the humeral head or prosthesis is dislocated to facilitate inspection of the joint structures. If a foreign body is present, it may include either a deep foreign body from a traumatic injury or an implanted device like a total shoulder prosthesis. The removal process involves careful extraction of the foreign body, ensuring that any associated materials, such as bone cement, are also addressed. Post-removal, the bony surfaces are smoothed to promote healing and prepare for any potential subsequent procedures, such as the placement of a new prosthesis or the insertion of a drain in cases of infection. This comprehensive approach ensures that the procedure is thorough and addresses all aspects of the foreign body removal, particularly in complex cases involving total shoulder prostheses.

1. Indications

The procedure described by CPT® Code 23332 is indicated in specific scenarios where the removal of a complicated foreign body from the shoulder is necessary. The following conditions may warrant this procedure:

Complicated Foreign Body Presence The presence of a complicated foreign body, such as a total shoulder prosthesis, that requires surgical intervention for removal.
Infection Situations where an infection is associated with the implanted device, necessitating its removal to prevent further complications.
Traumatic Injury Cases involving penetrating foreign bodies resulting from trauma that may have compromised the shoulder joint.

2. Procedure

The procedure for the removal of a complicated foreign body from the shoulder, as outlined in CPT® Code 23332, involves several critical steps:

Step 1: Skin Incision A skin incision is made over the shoulder joint to provide access to the underlying structures. This incision is strategically placed to facilitate the subsequent dissection and exposure of the joint.
Step 2: Dissection of Soft Tissues The surgeon carefully dissects through the soft tissues surrounding the shoulder joint. This step is essential to reach the joint capsule, which must be opened to access the foreign body.
Step 3: Exposure of the Joint Capsule Once the soft tissues are dissected, the joint capsule is exposed and opened. This allows for direct visualization of the shoulder joint components, including the humeral head and glenoid.
Step 4: Dislocation of Humeral Head or Prosthesis The humeral head or the total shoulder prosthesis is dislocated to enable thorough inspection of the joint structures. This step is crucial for identifying and accessing the foreign body.
Step 5: Removal of the Foreign Body The complicated foreign body, such as a total shoulder prosthesis, is carefully removed. This may involve freeing the implant from the humerus or glenoid cavity, ensuring that any associated materials, such as bone cement, are also extracted.
Step 6: Smoothing of Bony Surfaces After the foreign body is removed, the bony surfaces are smoothed to promote healing and prepare the site for any potential subsequent procedures.
Step 7: Closure If necessary, a drain may be placed in cases of infection, and the soft tissues are closed around the drain to facilitate recovery.

3. Post-Procedure

Post-procedure care following the removal of a complicated foreign body from the shoulder involves monitoring for any signs of infection or complications. Patients may require follow-up visits to assess the healing process and ensure that the surgical site is recovering appropriately. If a drain was placed, it will need to be monitored and managed according to the physician's instructions. Additionally, rehabilitation may be necessary to restore function and strength to the shoulder joint, depending on the extent of the procedure and the patient's overall condition.

Short Descr	REMOVE SHOULDER FOREIGN BODY
Medium Descr	REMOVAL FOREIGN BODY SHOULDER COMPLICATED
Long Descr	Removal of foreign body, shoulder; complicated (eg, total shoulder)
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	Inpatient Procedures, not paid under OPPS
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	P3D - Major procedure, orthopedic - other
MUE	Not applicable/unspecified.
CCS Clinical Classification	162 - Other OR therapeutic procedures on joints