How To Use CPT Code 23100

CPT code 23100 describes the procedure of arthrotomy, specifically for the glenohumeral joint, which includes a biopsy. 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 23100?

CPT 23100 is a code used to describe the arthrotomy procedure performed on the glenohumeral joint, which involves making an incision to expose the joint and taking a biopsy of the tissue inside. This procedure is typically done to investigate recurrent infection or inflammation in the shoulder joint.

2. Official Description

The official description of CPT code 23100 is: ‘Arthrotomy, glenohumeral joint, including biopsy.’

3. Procedure

During the arthrotomy procedure (CPT 23100), the healthcare provider begins by preparing and anesthetizing the patient. They then make a proximal incision over the glenohumeral joint to gain access to the joint capsule. The provider carefully dissects the tissues to visualize the joint capsule and subsequently incises it to expose the joint. Once the joint is exposed, the provider takes a biopsy of the tissue from inside the joint for further analysis. Finally, the surgical wound is closed. This procedure is typically performed when there is a suspicion of recurrent infection or inflammation in the glenohumeral joint.

4. Qualifying circumstances

CPT code 23100 is used when the patient presents with recurrent infection or inflammation in the glenohumeral joint. The procedure is performed by a healthcare provider who is qualified to perform arthrotomies and biopsies. It is important to note that this code is specific to the glenohumeral joint and should not be used for arthrotomies performed on other joints.

5. When to use CPT code 23100

CPT code 23100 should be used when the healthcare provider performs an arthrotomy on the glenohumeral joint and includes a biopsy of the tissue. This code is appropriate when there is a suspicion of recurrent infection or inflammation in the shoulder joint and the provider needs to investigate further by obtaining a tissue sample for analysis.

6. Documentation requirements

To support a claim for CPT code 23100, the healthcare provider must document the following information:

• Patient’s diagnosis indicating the need for the arthrotomy procedure
• Details of the procedure performed, including the incision made, visualization of the joint capsule, incision of the joint capsule, and the biopsy taken
• Date of the procedure
• Any additional findings or complications encountered during the procedure
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT code 23100, ensure that the procedure performed is specifically an arthrotomy of the glenohumeral joint with a biopsy. It is important to follow the appropriate coding guidelines and ensure accurate documentation to support the claim. There are no specific guidelines regarding reporting CPT code 23100 with other codes, so it should be reported independently when performed.

8. Historical information

CPT code 23100 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 23100

There are several similar codes to CPT code 23100 that describe other excision procedures on the shoulder. These codes include:

• CPT 23065: Excision, tumor, soft tissue of shoulder area, subcutaneous
• CPT 23066: Excision, tumor, soft tissue of shoulder area, deep
• CPT 23075: Excision, tumor, soft tissue of shoulder area, subfascial (eg, intramuscular)
• CPT 23101: Arthrotomy, glenohumeral joint, with synovectomy
• CPT 23220: Excision, tumor, soft tissue of shoulder area, subfascial (eg, intramuscular); deep

9. Examples

1. A patient with recurrent shoulder infections undergoes an arthrotomy of the glenohumeral joint with a biopsy to investigate the cause of the infections.
2. A healthcare provider performs an arthrotomy and biopsy on a patient with chronic shoulder inflammation to determine the underlying cause.
3. An individual with a history of shoulder pain and swelling undergoes an arthrotomy procedure with a biopsy to evaluate for any underlying pathology.
4. A patient with a suspected shoulder joint infection undergoes an arthrotomy and biopsy to obtain a tissue sample for analysis.
5. A healthcare provider performs an arthrotomy and biopsy on a patient with persistent shoulder inflammation to aid in diagnosis and treatment planning.
6. An individual with a history of shoulder trauma undergoes an arthrotomy procedure with a biopsy to assess for any internal joint damage.
7. A patient with recurrent shoulder joint effusion undergoes an arthrotomy and biopsy to determine the cause of the fluid accumulation.
8. A healthcare provider performs an arthrotomy and biopsy on a patient with suspected shoulder joint infection to identify the causative organism.
9. An individual with a history of shoulder instability undergoes an arthrotomy procedure with a biopsy to assess the integrity of the joint structures.
10. A patient with persistent shoulder pain and limited range of motion undergoes an arthrotomy and biopsy to investigate the underlying cause.