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Official Description

Open treatment of clavicular fracture, includes internal fixation, when performed

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

An open treatment of a clavicular fracture involves a surgical procedure where the fractured clavicle is directly accessed through an incision. This method is utilized when a fracture is not adequately aligned or stabilized through non-surgical means. The procedure begins with the surgeon making an incision over the fracture site to expose the bone. Once the fracture is visible, the ends of the fractured bone are carefully cleaned and aligned to restore their anatomical position. If the fracture requires stabilization, internal fixation techniques are employed. This may involve the use of guide pins and screws, which are inserted into the clavicle to hold the bone fragments together securely. The use of fluoroscopic guidance ensures precise placement of these fixation devices. Depending on the specific needs of the fracture, various fixation methods may be utilized, including cannulated screws, washers, or plates, to maintain the proper alignment of the clavicle during the healing process. This open treatment approach is essential for ensuring optimal recovery and function of the shoulder girdle following a clavicular fracture.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The open treatment of a clavicular fracture is indicated in specific clinical scenarios where non-surgical management is insufficient. The following conditions warrant this procedure:

  • Displaced Clavicular Fracture A fracture where the bone ends are not aligned and require surgical intervention to restore proper positioning.
  • Comminuted Fracture A fracture that results in multiple fragments of the clavicle, necessitating stabilization to ensure healing.
  • Fracture with Associated Neurovascular Injury A fracture that compromises nearby nerves or blood vessels, requiring surgical correction to prevent further complications.
  • Nonunion or Malunion of Previous Fracture Cases where a previously fractured clavicle has not healed correctly or has healed in an improper position, requiring surgical intervention to correct.

2. Procedure

The procedure for the open treatment of a clavicular fracture involves several critical steps to ensure proper alignment and stabilization of the bone.

  • Step 1: Incision and Exposure The surgeon begins by making an incision over the site of the clavicular fracture. This incision allows for direct access to the fractured bone, enabling the surgeon to visualize and manipulate the fracture ends effectively.
  • Step 2: Debridement and Alignment Once the fracture is exposed, the ends of the fractured clavicle are debrided, meaning any damaged or necrotic tissue is removed. The surgeon then carefully aligns the fracture ends to restore their anatomical position, which is crucial for proper healing.
  • Step 3: Internal Fixation Preparation If internal fixation is deemed necessary, a guide pin is inserted medially into the clavicle using fluoroscopic guidance. This imaging technique helps ensure accurate placement of the pin. The pin is then overdrilled to accommodate the appropriate length screw.
  • Step 4: Lateral Clavicle Fixation After the medial guide pin is placed, it is removed and passed into the lateral clavicle. This step is similarly performed by overdrilling to fit the screw length, ensuring that both ends of the fracture are secured.
  • Step 5: Full-Length Pin Redirection The guide pin is directed out the back of the clavicle, and a drill is attached to the pin. The pin is then redirected through the full length of the clavicle, allowing for secure fixation.
  • Step 6: Placement of Fixation Devices A cannulated screw and washer are then placed from the back of the clavicle down the center to provide internal fixation. Alternatively, the surgeon may opt to use a reconstruction locking plate, a clavicle hook, or multiple screws to maintain the alignment of the fracture ends, depending on the specific requirements of the fracture.

3. Post-Procedure

After the open treatment of a clavicular fracture, the patient will typically be monitored for any immediate complications. Post-procedure care includes immobilization of the shoulder to allow for proper healing of the fracture. Patients may be advised to follow up with their healthcare provider for regular assessments of the healing process. Rehabilitation exercises may be introduced gradually to restore range of motion and strength, but these should be guided by a healthcare professional to ensure safety and effectiveness. The expected recovery time can vary based on the severity of the fracture and the individual patient's healing response.

Short Descr OPTX CLAVICULAR FX W/INT FIX
Medium Descr OPEN TX CLAVICULAR FRACTURE INTERNAL FIXATION
Long Descr Open treatment of clavicular fracture, includes internal fixation, when performed
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) P5B - Ambulatory procedures - musculoskeletal
MUE 1
CCS Clinical Classification 148 - Other fracture and dislocation procedure

This is a primary code that can be used with these additional add-on codes.

20702 Add-on Code MPFS Status: Active Code APC N Manual preparation and insertion of drug-delivery device(s), intramedullary (List separately in addition to code for primary procedure)
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
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.
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).
53 Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
54 Surgical care only: when 1 physician or other qualified health care professional performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding modifier 54 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.
62 Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate.
76 Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
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).
81 Minimum assistant surgeon: minimum surgical assistant services are identified by adding modifier 81 to the usual procedure number.
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)
GA Waiver of liability statement issued as required by payer policy, individual case
GC This service has been performed in part by a resident under the direction of a teaching physician
GW Service not related to the hospice patient's terminal condition
SG Ambulatory surgical center (asc) facility service
X4 Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period
XE Separate encounter, a service that is distinct because it occurred during a separate encounter
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
Date
Action
Notes
2023-01-01 Note Short description changed.
2008-01-01 Changed Code description changed.
Pre-1990 Added Code added.
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