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The CPT® Code 23491 refers to the prophylactic treatment of the proximal humerus, 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 bone, 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 proximal humerus, thereby reducing the likelihood of fractures or further bone deterioration. The techniques employed can vary; for instance, pins or screws may be inserted using a minimally invasive percutaneous approach, which involves making a small incision at the site of insertion. Radiographic guidance is often utilized to ensure accurate placement of these devices. In some cases, a hollow cannulated screw may be used, allowing for the injection of bone cement, specifically methylmethacrylate, directly into the bone to further reinforce it. Alternatively, if a more extensive approach is required, an incision may be made to expose the bone, allowing for the placement of internal fixation devices such as plates or wires. This comprehensive approach to treatment is crucial for patients with compromised bone health, as it aims to stabilize the bone and promote better outcomes.
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The prophylactic treatment represented by CPT® Code 23491 is indicated for patients who exhibit conditions that compromise the structural integrity of the proximal humerus. These indications include:
The procedure for CPT® Code 23491 involves several key steps to ensure effective prophylactic treatment of the proximal humerus:
Post-procedure care for patients undergoing CPT® Code 23491 includes monitoring for any signs of complications such as infection or improper healing. Patients may be advised to limit movement of the affected arm to allow for proper recovery. Follow-up appointments are essential to assess the stability of the fixation devices and the overall healing of the bone. Rehabilitation may be recommended to restore function and strength to the shoulder area, depending on the patient's specific condition and recovery progress.
| Short Descr | REINFORCE SHOULDER BONES | Medium Descr | PROPH TX W/WO METHYLMETHACRYLATE PROX HUMERUS | Long Descr | Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; proximal humerus | 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 | Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate. | 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 |
| 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 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). | 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). | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | 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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