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The CPT® Code 23490 refers to the prophylactic treatment of the clavicle, which involves the use of various techniques such as nailing, pinning, plating, or wiring. This procedure is specifically designed to enhance the structural integrity of the clavicle, particularly in patients who are at risk due to conditions like osteoporosis or osteolytic diseases, which may arise from bone metastases. The treatment aims to provide additional strength and support to the bone, thereby reducing the likelihood of fractures or further complications. The techniques employed can vary; for instance, a percutaneous approach may be utilized where a small incision is made at the site of screw insertion. Radiographic guidance is often employed to accurately place pins or screws into the clavicle or proximal humerus. In some cases, a hollow cannulated screw may be inserted, allowing for the injection of bone cement, known as methylmethacrylate, directly into the bone to enhance its stability. Alternatively, the procedure may involve drilling into the bone to inject the cement directly. If a plate and screw or wire cerclage method is chosen, a larger incision is made to expose the bone, allowing for the placement of internal fixation devices that provide necessary support. The procedure concludes with a layered closure of the surgical site, ensuring proper healing and recovery.
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The prophylactic treatment of the clavicle using CPT® Code 23490 is indicated for patients who are at increased risk of bone fractures due to specific medical conditions. These indications include:
The procedure for prophylactic treatment of the clavicle involves several key steps, which are detailed as follows:
Post-procedure care for patients undergoing prophylactic treatment of the clavicle includes monitoring for any signs of complications, such as infection or improper healing. Patients may be advised to limit movement of the affected area to allow for proper recovery. Follow-up appointments are typically scheduled to assess the healing process and ensure that the fixation devices are functioning as intended. Rehabilitation exercises may be recommended to restore strength and mobility once the initial healing phase is complete.
| Short Descr | REINFORCE CLAVICLE | Medium Descr | PROPH TX W/WO METHYLMETHACRYLATE CLAVICLE | Long Descr | Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; clavicle | 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) | 0 - Co-surgeons not permitted for this procedure. | 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 | 161 - Other OR therapeutic procedures on 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. | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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) |
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| Pre-1990 | Added | Code added. |
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