How To Use CPT Code 23430

CPT 23430 is a surgical procedure code for tenodesis of the long tendon of the biceps, and this article will cover its description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples.

1. What is CPT 23430?

CPT 23430 is a surgical procedure code that refers to the tenodesis of the long tendon of the biceps. This procedure is performed to restore function and stability to patients with severe damage to the biceps tendon due to conditions such as recurrent shoulder impingement or degenerative changes in the shoulder joint.

2. 23430 CPT code description

The official description of CPT code 23430 is: “Tenodesis of long tendon of biceps.”

3. Procedure

The CPT 23430 procedure involves the following steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider makes an incision in the skin and dissects down through the subcutaneous tissue to access the joint and the bicep tendon.
3. The damaged portion of the long tendon of the biceps is removed.
4. The remaining stump of the bicep tendon is sutured to the upper end of the humerus bone after drilling holes in the bone.
5. A stay suture is passed through the tendon stump, and a simple knot is tied and sutured to keep it in place.
6. The provider uses a drill to make a hole in the bone, passes the knotted tendon through the hole, and secures it with an absorbable suture, anchor, or screw.
7. All bleeding is stopped, and the wound is closed by suturing the soft tissue in layers.

4. Qualifying circumstances

Patients eligible to receive CPT code 23430 services are those with severe damage to the biceps tendon due to conditions such as recurrent shoulder impingement or degenerative changes in the shoulder joint. The damage must be significant enough to warrant surgical intervention, and conservative treatment options should have been exhausted or deemed ineffective.

5. When to use CPT code 23430

It is appropriate to bill the 23430 CPT code when the provider performs a tenodesis of the long tendon of the biceps to restore function and stability to patients with severe damage to the biceps tendon. This procedure is typically performed when conservative treatment options have failed or are deemed ineffective.

6. Documentation requirements

To support a claim for CPT 23430, the following information should be documented:

• Patient’s medical history, including the diagnosis of the underlying condition causing the biceps tendon damage.
• Physical examination findings, including the severity of the damage and the impact on the patient’s function and stability.
• Conservative treatment options attempted or considered, and their outcomes.
• Details of the surgical procedure, including the approach, techniques used, and any complications encountered.
• Postoperative care plan, including follow-up appointments and rehabilitation recommendations.

7. Billing guidelines

When billing for CPT code 23430, it is essential to follow the appropriate guidelines and rules. Some tips and codes that apply to CPT code 23430 include:

• Ensure that the documentation supports the medical necessity of the procedure and includes all required information as outlined in the documentation requirements section.
• Verify that the patient’s diagnosis and the severity of their condition warrant the use of CPT code 23430.
• Use appropriate modifiers when necessary, such as -22 for increased procedural services or -51 for multiple procedures performed during the same session.
• Be aware of any payer-specific guidelines or requirements for billing CPT code 23430.

8. Historical information

CPT 23430 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Similar codes to CPT 23430

Five similar codes to CPT 23430 and how they differentiate from CPT 23430 are:

1. CPT 23410: This code refers to the repair of the rotator cuff, which is a different structure within the shoulder joint.
2. CPT 23412: This code involves the repair of the rotator cuff with an acromioplasty, which includes additional surgical steps to address bone spurs or other issues with the acromion.
3. CPT 23420: This code is for the reconstruction of the shoulder joint, which is a more extensive procedure than tenodesis of the long tendon of the biceps.
4. CPT 23440: This code refers to the tenodesis of the short tendon of the biceps, which is a different tendon within the shoulder joint.
5. CPT 29828: This code is for arthroscopic biceps tenodesis, which is a minimally invasive approach to the tenodesis procedure.

10. Examples

Here are 10 detailed examples of CPT code 23430 procedures:

1. A 45-year-old patient with a history of recurrent shoulder impingement undergoes tenodesis of the long tendon of the biceps after conservative treatments have failed to provide relief.
2. A 60-year-old patient with degenerative changes in the shoulder joint undergoes CPT 23430 to restore function and stability to the joint.
3. A patient with a traumatic injury to the shoulder resulting in severe damage to the long tendon of the biceps undergoes CPT code 23430 to repair the tendon and restore function.
4. A patient with a chronic biceps tendon tear that has not responded to conservative treatments undergoes tenodesis of the long tendon of the biceps using CPT 23430.
5. A patient with a history of multiple shoulder dislocations and significant damage to the long tendon of the biceps undergoes CPT 23430 to stabilize the joint and prevent further dislocations.
6. A patient with a degenerative rotator cuff tear and associated damage to the long tendon of the biceps undergoes CPT code 23430 in conjunction with rotator cuff repair.
7. A patient with a history of shoulder instability and recurrent subluxations undergoes tenodesis of the long tendon of the biceps using CPT 23430 to improve joint stability.
8. A patient with a chronic biceps tendonitis that has not responded to conservative treatments undergoes CPT code 23430 to alleviate pain and restore function.
9. A patient with a partial tear of the long tendon of the biceps that has not healed with conservative treatments undergoes CPT 23430 to repair the tendon and prevent further damage.
10. A patient with a history of shoulder impingement syndrome and significant damage to the long tendon of the biceps undergoes tenodesis of the long tendon of the biceps using CPT code 23430 to alleviate pain and improve function.