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The CPT® Code 23665 refers to the closed treatment of a shoulder dislocation that is accompanied by a fracture of the greater humeral tuberosity, utilizing manipulation techniques. This procedure involves the closed reduction of a shoulder dislocation, which is a condition where the humeral head is displaced from its normal position in the glenohumeral joint. In this specific case, the dislocation is complicated by a fracture of the greater humeral tuberosity, a bony prominence on the humerus where the rotator cuff muscles attach. The injury typically results in the displacement of the greater tuberosity and the retraction of the rotator cuff musculature, while the humeral head and lesser tuberosity are dislocated. The manipulation technique employed during the procedure is tailored to the specific direction of the dislocation and the physician's preference, often involving a combination of traction, countertraction, and rotational movements to restore the humeral head to its proper anatomical position. After the dislocation is reduced, imaging studies such as radiographs are performed to confirm the correct alignment of the shoulder joint and the positioning of the fractured fragments. If necessary, further manipulation of the fracture fragments is conducted to ensure proper alignment. Once the anatomical alignment is achieved, the shoulder is immobilized, typically in a cast, to facilitate healing and prevent further injury.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 23665 is indicated for patients presenting with a shoulder dislocation that is complicated by a fracture of the greater humeral tuberosity. This condition may arise from traumatic events such as falls, sports injuries, or accidents, where the shoulder is subjected to significant force. Symptoms that may prompt this procedure include severe shoulder pain, visible deformity of the shoulder, limited range of motion, and swelling around the joint. The presence of a fracture in conjunction with the dislocation necessitates careful manipulation to ensure proper healing and restoration of function.
The closed treatment of a shoulder dislocation with a fracture of the greater humeral tuberosity involves several key procedural steps. First, the physician assesses the patient's shoulder to confirm the dislocation and the presence of the fracture. Once confirmed, the physician prepares the patient for the manipulation process. The exact technique for manipulation is determined based on the direction of the dislocation and the physician's preference. This may involve applying traction and countertraction to the arm while simultaneously rotating the shoulder internally or externally. The goal of this manipulation is to guide the humeral head back into its proper position within the glenohumeral joint. After the reduction is achieved, the physician obtains radiographs to verify that the humeral head is correctly aligned and to check the positioning of the fracture fragments of the greater humeral tuberosity. If the imaging reveals any misalignment or displacement of the fracture fragments, additional manipulation may be performed to correct this. Once anatomic alignment is confirmed through imaging, the shoulder is immobilized, typically using a cast, to ensure stability and promote healing during the recovery process.
Following the closed treatment procedure for shoulder dislocation with a fracture of the greater humeral tuberosity, the patient will typically require a period of immobilization to allow for proper healing. The shoulder is usually placed in a cast or a sling to restrict movement and provide support. The physician may schedule follow-up appointments to monitor the healing process through physical examinations and additional imaging studies as needed. Patients are often advised on pain management strategies and may be prescribed analgesics to alleviate discomfort. Rehabilitation exercises may be introduced gradually, depending on the healing progress, to restore range of motion and strength to the shoulder. It is essential for patients to adhere to the post-procedure care instructions to ensure optimal recovery and prevent complications such as stiffness or re-dislocation.
| Short Descr | CLTX SHO DSLC FX GR HMRL TBR | Medium Descr | CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MNPJ | Long Descr | Closed treatment of shoulder dislocation, with fracture of greater humeral tuberosity, with manipulation | 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) | 1 - Statutory payment restriction for assistants at surgery applies 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) | P5B - Ambulatory procedures - musculoskeletal | MUE | 1 | CCS Clinical Classification | 148 - Other fracture and dislocation procedure |
| 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). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient 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). | 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. | 55 | Postoperative management only: when 1 physician or other qualified health care professional performed the postoperative management and another performed the surgical procedure, the postoperative component may be identified by adding modifier 55 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. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 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.) | 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). | AG | Primary physician | 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) | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | RT | Right side (used to identify procedures performed on the right side of the body) | 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 |
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| 2023-01-01 | Note | Short and medium descriptions changed. |
| Pre-1990 | Added | Code added. |
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