How To Use CPT Code 23472

CPT 23472 refers to a total shoulder arthroplasty procedure, which involves replacing the damaged head of the humerus and the glenoid cavity with prosthetic implants. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 23472.

1. What is CPT 23472?

CPT 23472 is a medical procedure code used to describe a total shoulder arthroplasty, in which the damaged head of the humerus and the glenoid cavity are replaced with prosthetic implants. This procedure is performed to treat severe arthritis of the shoulder joint and aims to relieve pain and disability in a severely damaged shoulder.

2. 23472 CPT code description

The official description of CPT code 23472 is: “Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement (eg, total shoulder))”.

3. Procedure

The 23472 procedure involves the following steps:

1. Preparation of the patient, including anesthesia administration.
2. Incision across the front of the shoulder from the middle of the collarbone to the middle of the arm bone.
3. Dissection of subcutaneous tissue to access the joint.
4. Retraction of muscles, nerves, and blood vessels.
5. Incision of the joint capsule and dislocation of the glenohumeral joint.
6. Removal of loose bodies present in the cavity.
7. Preparation of the glenoid cavity for the artificial implant.
8. Placement of the artificial glenoid component using bone cement.
9. Incision and removal of the damaged head of the humerus.
10. Placement of a prosthetic humeral head implant stem into the humerus shaft.
11. Alignment and reduction of the prosthetic humerus head into the glenoid component.
12. Possible acromioplasty to decompress soft tissue structures.
13. Suturing of muscles around the joint for stabilization.
14. Removal of osteophytes around the joint.
15. Control of bleeding, placement of drains, and closure of the wound.
16. Placement of the shoulder in a brace or sling for healing.

4. Qualifying circumstances

Patients eligible to receive CPT code 23472 services are those with severe arthritis of the shoulder joint, resulting in significant pain and disability. This procedure is typically recommended when conservative treatments, such as physical therapy, medications, and injections, have failed to provide adequate relief. Patients should have a thorough evaluation by a qualified healthcare provider to determine if they are suitable candidates for this procedure.

5. When to use CPT code 23472

It is appropriate to bill the 23472 CPT code when a total shoulder arthroplasty is performed to treat severe arthritis of the shoulder joint, and the patient has not responded to conservative treatments. The procedure should be performed by a qualified healthcare provider, and the patient should meet the qualifying circumstances mentioned above.

6. Documentation requirements

Documentation supporting a claim for CPT 23472 should include:

• A detailed medical history, including the patient’s symptoms, previous treatments, and response to conservative therapies.
• A thorough physical examination, including range of motion, strength, and stability assessments.
• Imaging studies, such as X-rays or MRI, showing the extent of joint damage and arthritis.
• A clear indication that the patient meets the qualifying circumstances for the procedure.
• A detailed operative report, including a description of the procedure, the prosthetic components used, and any complications encountered.
• Postoperative care instructions and follow-up plans.

7. Billing guidelines

When billing for CPT code 23472, it is essential to follow the appropriate guidelines and rules. Ensure that the patient meets the qualifying circumstances and that the documentation requirements are met. Additionally, be aware of any specific payer policies or requirements related to this procedure. It is also important to be familiar with any related codes, such as those for shoulder hemiarthroplasty (CPT 23470) or revision of total shoulder arthroplasty (CPT 23473).

8. Historical information

CPT 23472 was added to the Current Procedural Terminology system on January 1, 1990. In 2017, it was added to the Medicare Inpatient Only (IPO) list, and in 2021, it was removed from the IPO list.

9. Similar codes to CPT 23472

Five similar codes to CPT 23472 and how they differentiate are:

1. CPT 23470: This code is used for shoulder hemiarthroplasty, where only the humeral head is replaced, and the glenoid cavity is not.
2. CPT 23473: This code is used for the revision of total shoulder arthroplasty, including allograft when performed, for either the humeral or glenoid component.
3. CPT 23334: This code is used for the removal of total shoulder implants.
4. CPT 23335: This code is used for the removal of total shoulder implants with the insertion of spacer.
5. CPT 24400: This code is used for osteotomy of the proximal humerus.

10. Examples

Here are 10 detailed examples of CPT code 23472 procedures:

1. A 65-year-old patient with severe osteoarthritis of the shoulder joint, unresponsive to conservative treatments, undergoes a total shoulder arthroplasty.
2. A 70-year-old patient with rheumatoid arthritis and significant shoulder joint damage undergoes a total shoulder arthroplasty to relieve pain and improve function.
3. A 55-year-old patient with post-traumatic arthritis of the shoulder joint following a previous fracture undergoes a total shoulder arthroplasty.
4. A 60-year-old patient with severe shoulder joint degeneration due to avascular necrosis undergoes a total shoulder arthroplasty.
5. A 67-year-old patient with rotator cuff tear arthropathy and significant shoulder joint damage undergoes a total shoulder arthroplasty.
6. A 72-year-old patient with severe shoulder joint arthritis and a history of failed shoulder joint injections undergoes a total shoulder arthroplasty.
7. A 58-year-old patient with a history of shoulder joint instability and severe arthritis undergoes a total shoulder arthroplasty.
8. A 63-year-old patient with a history of multiple shoulder surgeries and severe joint arthritis undergoes a total shoulder arthroplasty.
9. A 75-year-old patient with severe shoulder joint arthritis and a history of failed physical therapy and medications undergoes a total shoulder arthroplasty.
10. A 68-year-old patient with a history of shoulder joint dislocations and severe arthritis undergoes a total shoulder arthroplasty.