How To Use CPT Code 23101

CPT code 23101 describes the surgical procedure known as arthrotomy, specifically for the acromioclavicular joint or sternoclavicular joint. 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 23101?

CPT 23101 is a code used to describe the surgical procedure of arthrotomy, which involves making an incision in either the acromioclavicular joint or the sternoclavicular joint. This procedure may include the removal of torn cartilage, biopsy of tissue for analysis, or both. The purpose of this surgery is to alleviate pain, restore mobility, and obtain a tissue sample for further examination.

2. Official Description

The official description of CPT code 23101 is: ‘Arthrotomy, acromioclavicular joint or sternoclavicular joint, including biopsy and/or excision of torn cartilage.’

3. Procedure

During the arthrotomy procedure, the healthcare provider begins by preparing the patient and administering anesthesia. Once the patient is appropriately prepped and anesthetized, the provider makes an incision over the joint, extending it down to the joint capsule. The joint capsule is then incised to gain access to the structures within. The provider may take a tissue sample for analysis and diagnosis, if necessary. Additionally, any torn cartilage present may be excised. After completing the necessary steps, the provider irrigates the area, checks for bleeding, removes any instruments, and closes the incision.

4. Qualifying circumstances

CPT 23101 is typically performed on patients who are experiencing pain or limited mobility in either the acromioclavicular joint or the sternoclavicular joint. The procedure may be necessary to remove torn cartilage or obtain a tissue sample for further analysis. It is important to note that this procedure should only be performed by a qualified healthcare professional with the appropriate training and expertise.

5. When to use CPT code 23101

CPT code 23101 should be used when a healthcare professional performs an arthrotomy on either the acromioclavicular joint or the sternoclavicular joint, including the excision of torn cartilage and/or biopsy of tissue. This code should be used for each individual joint that undergoes the procedure.

6. Documentation requirements

To support a claim for CPT 23101, the healthcare professional must document the following information:

• Patient’s diagnosis and the need for arthrotomy
• Specific joint (acromioclavicular or sternoclavicular) targeted for the procedure
• Date of the procedure
• Details of the incision and access to the joint capsule
• Any tissue samples obtained for analysis
• Excision of torn cartilage, if applicable
• Post-procedure care and instructions
• Signature of the healthcare professional performing the procedure

7. Billing guidelines

When billing for CPT 23101, ensure that the procedure is performed on either the acromioclavicular joint or the sternoclavicular joint, and that it includes the excision of torn cartilage and/or biopsy of tissue. It is important to follow the appropriate coding guidelines and modifiers, if applicable, to accurately report the procedure. Additionally, be aware of any specific billing requirements or restrictions set by insurance providers or regulatory bodies.

8. Historical information

CPT 23101 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 23101

There are several similar codes to CPT 23101 that describe other excision procedures on the shoulder. These codes include:

• CPT 23065: Excision of tumor, soft tissue of shoulder area, subcutaneous
• CPT 23066: Excision of tumor, soft tissue of shoulder area, deep
• CPT 23075: Excision of tumor, bone of shoulder area
• CPT 23100: Arthrotomy, shoulder, with exploration, drainage, or removal of foreign body
• CPT 23220: Excision, excessive bone and cartilage (e.g., osteochondroma, enchondroma, chondromyxoid fibroma), shoulder area

9. Examples

1. A patient undergoes arthrotomy of the acromioclavicular joint to remove torn cartilage and obtain a tissue sample for analysis.
2. A healthcare professional performs arthrotomy of the sternoclavicular joint to excise torn cartilage and biopsy suspicious tissue.
3. An individual undergoes arthrotomy of both the acromioclavicular and sternoclavicular joints to address torn cartilage and obtain tissue samples for further examination.
4. A patient with persistent shoulder pain undergoes arthrotomy of the acromioclavicular joint to remove torn cartilage and alleviate symptoms.
5. A healthcare professional performs arthrotomy of the sternoclavicular joint to biopsy a suspicious mass and determine the appropriate course of treatment.
6. An individual undergoes arthrotomy of the acromioclavicular joint to excise torn cartilage and improve shoulder mobility.
7. A patient with a history of shoulder trauma undergoes arthrotomy of the sternoclavicular joint to remove damaged cartilage and restore joint function.
8. A healthcare professional performs arthrotomy of the acromioclavicular joint to obtain a tissue sample for analysis and diagnose a suspected condition.
9. An individual undergoes arthrotomy of the sternoclavicular joint to address chronic pain and remove torn cartilage.
10. A patient with a known shoulder injury undergoes arthrotomy of the acromioclavicular joint to excise torn cartilage and improve overall shoulder function.