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The procedure described by CPT® Code 23680 refers to the open treatment of a shoulder dislocation that is accompanied by a fracture of the surgical or anatomical neck of the humerus. This procedure involves an open reduction, which means that the dislocated shoulder is surgically repositioned into its correct anatomical location. In cases where there is a fracture of the surgical neck, the greater and lesser tuberosities, which are bony prominences on the humeral head, typically remain attached. This is significant as it influences the surgical approach and fixation techniques used during the procedure. The surgical exposure is generally achieved through an anterior superior or deltopectoral approach, allowing the surgeon to access the shoulder joint effectively. Once the fracture-dislocation is visualized, the surgeon performs a reduction, which is the process of realigning the dislocated joint. Depending on the specific characteristics of the fracture, various fixation methods may be employed to stabilize the shoulder. For instance, unstable oblique or spiral fractures may require the application of a plate for fixation. Other techniques may include creating drill holes in the humeral shaft below the fracture site and using figure-of-eight sutures for stabilization. Additionally, Enders nails, which are a type of intramedullary fixation device, may be utilized along with tension sutures or wires to secure the fracture. This comprehensive approach ensures that both the dislocation and the associated fracture are adequately addressed, promoting optimal healing and recovery for the patient.
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The open treatment of shoulder dislocation with an associated surgical or anatomical neck fracture is indicated in specific clinical scenarios. These include:
The procedure for the open treatment of shoulder dislocation with a surgical or anatomical neck fracture involves several critical steps:
Post-procedure care following the open treatment of shoulder dislocation with a surgical or anatomical neck fracture typically involves monitoring for complications, managing pain, and initiating rehabilitation. Patients may be advised to keep the shoulder immobilized in a sling for a specified period to allow for healing. Physical therapy may be recommended to restore range of motion and strength as the healing progresses. Follow-up appointments are essential to assess the healing of the fracture and the stability of the shoulder joint.
| Short Descr | OPTX SHO DISLC NECK FX FIXJ | Medium Descr | OPTX SHO DISLC W/SURG/ANTMCL NECK FX INT FIXJ | Long Descr | Open treatment of shoulder dislocation, with surgical or anatomical neck 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) | P3D - Major procedure, orthopedic - other | MUE | 1 | CCS Clinical Classification | 148 - Other fracture and dislocation procedure |
| 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). | 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. | 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). | 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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| 2023-01-01 | Note | Short and medium descriptions changed. |
| 2008-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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