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The CPT® Code 23450 refers to a surgical procedure known as capsulorrhaphy, specifically an anterior repair of the shoulder capsule. This procedure is primarily indicated for treating instability of the glenohumeral joint, which is the ball-and-socket joint of the shoulder, and for addressing recurrent anterior dislocation of the shoulder. The procedure encompasses two specific techniques: the Putti-Platt procedure and the Magnuson type operation. In the Putti-Platt procedure, the subscapularis tendon, which is a key muscle in the shoulder, is shortened to effectively bring the head of the humerus, the bone of the upper arm, closer to the shoulder blade, thereby stabilizing the joint. The subscapularis muscle originates from the subscapular fossa of the scapula and inserts onto the anterior aspect of the humerus at the lesser tubercle. This tendon plays a crucial role in forming the shoulder joint capsule by fusing with other tendons. During the procedure, an incision is made over the anterior aspect of the shoulder joint, allowing for dissection of the soft tissue and opening of the joint capsule. The insertion point of the subscapularis tendon on the lesser tubercle is then exposed, allowing for detachment and longitudinal division of the tendon. The lateral free end is subsequently attached to the anterior rim of the glenoid, while the medial free end is sutured over the lateral end, effectively shortening and tightening the tendon. The Magnuson procedure follows a similar approach but involves detaching the subscapularis from the lesser tuberosity and reattaching it just lateral to the bicipital groove, creating a tendon sling that aids in maintaining the humeral head's position within the glenohumeral joint.
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The procedure described by CPT® Code 23450 is indicated for the following conditions:
The surgical procedure for CPT® Code 23450 involves several key steps that are critical for achieving the desired outcome of shoulder stabilization.
Post-procedure care following CPT® Code 23450 typically involves monitoring the patient for any complications and managing pain. Rehabilitation is crucial for recovery, and patients are often advised to engage in physical therapy to restore range of motion and strength in the shoulder. The expected recovery period may vary based on individual patient factors and the extent of the procedure performed. Patients should follow their surgeon's specific instructions regarding activity restrictions and rehabilitation protocols to ensure optimal healing and functional recovery.
| Short Descr | REPAIR SHOULDER CAPSULE | Medium Descr | CAPSULORRHAPHY ANTERIOR PUTTI-PLATT/MAGNUSON | Long Descr | Capsulorrhaphy, anterior; Putti-Platt procedure or Magnuson type operation | 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 | Non office-based surgical procedure added in CY 2008 or later; 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 | 162 - Other OR therapeutic procedures on joints |
| 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. | 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.) | 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) | SG | Ambulatory surgical center (asc) facility service | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| Pre-1990 | Added | Code added. |
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