How To Use CPT Code 23035

CPT code 23035 describes the incision of the bone cortex in the shoulder area to treat conditions such as osteomyelitis or bone abscess. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 23035?

CPT 23035 is a code used to describe the incision of the bone cortex in the shoulder area. This procedure is typically performed to treat conditions such as osteomyelitis or bone abscess. The provider makes a midline incision over the affected area, carefully removes any necrotic tissue or purulent material, and inserts a drainage tube. The incision is then closed after irrigation with antibiotic solution.

2. Official Description

The official description of CPT code 23035 is: ‘Incision, bone cortex (eg, osteomyelitis or bone abscess), shoulder area.’

3. Procedure

When performing CPT 23035, the provider begins by making a midline incision over the affected area in the shoulder. They then dissect through the muscle and fascia until they reach the bone cortex. Careful debridement is performed to remove any necrotic tissue or purulent material. A drainage tube is inserted to facilitate the drainage of any remaining infection. The provider irrigates the area with antibiotic solution, checks for bleeding, removes any instruments, and closes the incision.

4. Qualifying circumstances

CPT 23035 is typically performed on patients with conditions such as osteomyelitis or bone abscess in the shoulder area. These conditions are characterized by the presence of infection or pus within the bone. The procedure is performed by a qualified healthcare professional who has the necessary training and expertise to perform the incision and drainage. It is important to note that the procedure is specific to the shoulder area and should not be used for other anatomical locations.

5. When to use CPT code 23035

CPT code 23035 should be used when a provider performs an incision of the bone cortex in the shoulder area to treat conditions such as osteomyelitis or bone abscess. It is important to ensure that the procedure is performed in the appropriate anatomical location and that the documentation supports the medical necessity of the procedure.

6. Documentation requirements

To support a claim for CPT 23035, the healthcare professional must document the following information:

• Patient’s diagnosis, indicating the presence of osteomyelitis or bone abscess
• Details of the procedure, including the location of the incision and the extent of the debridement
• Use of antibiotic solution for irrigation
• Insertion of a drainage tube
• Any complications or additional procedures performed
• Signature of the healthcare professional performing the procedure

7. Billing guidelines

When billing for CPT 23035, ensure that the procedure is performed in the shoulder area and is medically necessary. It is important to follow the specific guidelines provided by the payer and to use the appropriate modifiers if required. It is also important to review any bundling or unbundling rules that may apply to ensure accurate billing.

8. Historical information

CPT 23035 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Similar codes to CPT 23035

There are several similar codes to CPT 23035 that are used to describe procedures on the shoulder area. These include:

• CPT 23000: Incision, shoulder area
• CPT 23020: Exploration, shoulder joint
• CPT 23025: Exploration, shoulder joint, with removal of foreign body or loose body
• CPT 23040: Incision and drainage, shoulder area; deep abscess or hematoma
• CPT 23044: Incision and drainage, shoulder area; deep abscess or hematoma, complicated

9. Examples

1. A patient presents with osteomyelitis in the shoulder area. The provider performs an incision of the bone cortex (CPT 23035) to remove the infected tissue and facilitate drainage.
2. A patient is diagnosed with a bone abscess in the shoulder. The provider performs an incision of the bone cortex (CPT 23035) to drain the abscess and promote healing.
3. A patient undergoes surgery for the treatment of osteomyelitis in the shoulder area. As part of the procedure, the provider performs an incision of the bone cortex (CPT 23035) to remove the infected tissue and ensure proper drainage.
4. A patient presents with a deep abscess in the shoulder area. The provider performs an incision of the bone cortex (CPT 23035) to drain the abscess and prevent further complications.
5. A patient is admitted to the hospital with a bone infection in the shoulder. The provider performs an incision of the bone cortex (CPT 23035) to remove the infected tissue and promote healing.
6. A patient undergoes a surgical procedure for the treatment of a bone abscess in the shoulder area. As part of the procedure, the provider performs an incision of the bone cortex (CPT 23035) to drain the abscess and ensure proper healing.
7. A patient presents with osteomyelitis in the shoulder area. The provider performs an incision of the bone cortex (CPT 23035) to remove the infected tissue and facilitate drainage.
8. A patient is diagnosed with a bone abscess in the shoulder. The provider performs an incision of the bone cortex (CPT 23035) to drain the abscess and promote healing.
9. A patient undergoes surgery for the treatment of osteomyelitis in the shoulder area. As part of the procedure, the provider performs an incision of the bone cortex (CPT 23035) to remove the infected tissue and ensure proper drainage.
10. A patient presents with a deep abscess in the shoulder area. The provider performs an incision of the bone cortex (CPT 23035) to drain the abscess and prevent further complications.