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Official Description

Open treatment of scapular fracture (body, glenoid or acromion) includes internal fixation, when performed

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The CPT® Code 23585 refers to the open treatment of a fracture involving the body, glenoid, or acromion of the scapula. This procedure may include internal fixation, which is a surgical method used to stabilize and secure the fractured bone fragments. The scapula, commonly known as the shoulder blade, plays a crucial role in shoulder mobility and stability. Fractures in this area can occur due to trauma, such as falls or accidents, and may significantly impact a patient's range of motion and overall shoulder function. The open treatment approach allows for direct visualization and manipulation of the fracture site, facilitating accurate alignment and stabilization of the bone fragments. Radiographs, or X-rays, are typically obtained to confirm the presence and extent of the fracture prior to surgical intervention. The surgical approach varies based on the specific location and type of scapular fracture, with techniques tailored to ensure optimal access and repair of the affected area. This procedure is essential for restoring the structural integrity of the scapula and promoting proper healing, ultimately aiding in the patient's recovery and return to normal activities.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The open treatment of scapular fractures is indicated for specific conditions and symptoms that necessitate surgical intervention. These include:

  • Fracture of the Scapula - This procedure is performed when there is a fracture involving the body, glenoid, or acromion of the scapula, which may result from trauma or injury.
  • Displacement of Fracture Fragments - Indications for surgery include cases where the fracture fragments are displaced, requiring realignment to restore normal anatomy and function.
  • Inability to Achieve Stability - When conservative treatment methods, such as immobilization, do not provide adequate stability or pain relief, surgical intervention may be necessary.
  • Associated Glenohumeral Joint Issues - If there are concurrent injuries to the glenohumeral joint that complicate the fracture, surgical treatment may be indicated to address both the fracture and any associated joint problems.

2. Procedure

The open treatment of scapular fractures involves several detailed procedural steps, which are as follows:

  • Step 1: Patient Positioning - The patient is positioned appropriately based on the type of scapular fracture. For anterior rim fractures, the patient is placed in a beach chair position, while posterior fractures may require a posterior or combined posterosuperior approach.
  • Step 2: Incision and Exposure - A surgical incision is made, typically extending over the lateral third of the scapular spine to the lateral tip of the acromion and then distally in a midlateral line. The deltoid muscle is carefully dissected off the scapular spine and acromion, and then split to provide access to the underlying structures.
  • Step 3: Muscle and Tendon Exposure - The infraspinatus and teres minor musculotendinous units are exposed, and the deltoid is retracted to the level of the inferior margin of the teres minor to facilitate access to the fracture site.
  • Step 4: Joint Capsule Access - The infraspinatus tendon is incised and dissected off the posterior glenohumeral capsule. The glenohumeral joint capsule is then opened, allowing the humeral head to be retracted to expose the glenoid cavity.
  • Step 5: Fracture Reduction - The fracture fragments are carefully reduced to restore anatomical alignment. If internal fixation is deemed necessary, temporary fixation using K-wires or screws is applied to maintain alignment during the procedure.
  • Step 6: Permanent Internal Fixation - Once the fracture fragments are aligned, permanent internal fixation is applied as needed. This may involve the use of an interfragmentary compression screw or a contoured reconstruction plate to secure the fragments in place.
  • Step 7: Postoperative Care - After the fixation is completed, the shoulder is immobilized by placing the arm in a sling to support the healing process and prevent movement that could disrupt the repair.

3. Post-Procedure

Post-procedure care following the open treatment of scapular fractures involves several important considerations. The shoulder is immobilized in a sling to provide support and limit movement during the initial healing phase. Patients are typically monitored for any signs of complications, such as infection or improper healing. Rehabilitation may be initiated based on the surgeon's recommendations, focusing on gradually restoring range of motion and strength. Follow-up appointments are essential to assess the healing process through radiographic evaluations and to adjust the rehabilitation plan as necessary. The overall recovery time can vary depending on the severity of the fracture and the patient's adherence to postoperative care instructions.

Short Descr OPTX SCAPULAR FX W/INT FIXJ
Medium Descr OPEN TX SCAPULAR FX W/INT FIXATION WHEN PFRMD
Long Descr Open treatment of scapular fracture (body, glenoid or acromion) 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) P3D - Major procedure, orthopedic - other
MUE 1
CCS Clinical Classification 148 - Other fracture and dislocation procedure
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
LT Left side (used to identify procedures performed on the left side of the body)
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.
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.
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.)
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).
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
RT Right side (used to identify procedures performed on the right side of the body)
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
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 and medium descriptions changed.
2009-01-01 Changed Code description changed
Pre-1990 Added Code added.
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