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The procedure described by CPT® Code 23420 involves the reconstruction of a complete shoulder (rotator) cuff avulsion that is chronic in nature, which includes an acromioplasty. The rotator cuff is a critical structure in the shoulder, composed of a group of muscles and tendons that facilitate the motion of the shoulder joint. This group includes the supraspinatus, infraspinatus, subscapularis, and teres minor, which work together to stabilize and move the shoulder. In cases of chronic avulsion, the rotator cuff tendons may become detached from their attachment on the humeral head, leading to pain and functional impairment. During the procedure, a surgical incision is made over the shoulder joint to access the affected area. The soft tissue surrounding the joint is carefully dissected to expose the joint capsule, which is then incised to allow for inspection of the joint structures. An acromioplasty is performed to alleviate any impingement by flattening and smoothing the underside of the acromion using specialized instruments. The surgeon evaluates the rotator cuff for tears, removing any thin or fragmented portions of the tendon. The reconstruction process involves suturing the torn tendon back together, and in cases of larger defects, additional techniques such as tendon mobilization or the advancement of tendon flaps may be employed. If necessary, the site for reattachment to the bone is prepared, and metallic anchors are used to secure the tendon to the humerus, ensuring proper alignment and stability. The procedure concludes with the flushing of the joint, closure of the incisions, and application of a dressing to promote healing.
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The procedure described by CPT® Code 23420 is indicated for patients experiencing chronic rotator cuff avulsion. This condition may present with various symptoms and is typically associated with the following:
The procedure for CPT® Code 23420 involves several critical steps to effectively reconstruct the rotator cuff. Each step is essential for ensuring a successful outcome:
After the completion of the procedure, patients can expect a recovery period that may involve pain management and rehabilitation. Post-operative care typically includes monitoring for any signs of infection, managing pain with prescribed medications, and following a structured physical therapy program to restore strength and range of motion in the shoulder. Patients are advised to avoid certain movements or activities that could stress the shoulder during the initial healing phase. Follow-up appointments are essential to assess the healing process and adjust rehabilitation protocols as necessary.
| Short Descr | REPAIR OF SHOULDER | Medium Descr | RECONSTRUCTION ROTATOR CUFF AVULSION CHRONIC | Long Descr | Reconstruction of complete shoulder (rotator) cuff avulsion, chronic (includes acromioplasty) | 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 | 154 - Arthroplasty other than hip or knee |
| 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) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | 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). | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 55 | Postoperative management only: when 1 physician or other qualified health care professional performed the postoperative management and another performed the surgical procedure, the postoperative component may be identified by adding modifier 55 to the usual procedure number. | 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | GC | This service has been performed in part by a resident under the direction of a teaching physician | SG | Ambulatory surgical center (asc) facility service | 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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