How To Use CPT Code 23155

CPT code 23155 describes the excision or curettage of a bone cyst or benign tumor of the proximal humerus with autograft. 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 23155?

CPT 23155 is used to describe the excision or curettage of a bone cyst or benign tumor of the proximal humerus with autograft. This procedure involves the removal of the cyst or tumor from the upper arm bone (humerus) using cutting or scraping instruments. The defect created by the removal is then filled with bone graft taken from another location in the patient’s body.

2. Official Description

The official description of CPT code 23155 is: ‘Excision or curettage of bone cyst or benign tumor of proximal humerus with autograft (includes obtaining graft).’

3. Procedure

During the procedure, the patient is appropriately prepped and anesthetized. The provider makes an incision in the upper arm over the area of the cyst or tumor. They then dissect down to the level of the bone and open the periosteum, which is the membrane covering the bone. Using an osteotome or bone curette, the provider excises the cyst or tumor down to healthy tissue. The excised specimen is sent to a laboratory for analysis. The provider then harvests bone graft material from another location, such as the iliac crest in the pelvis, through a small incision. The harvested bone graft is then used to fill the defect in the humerus. The area is irrigated, checked for bleeding, and all incisions are closed.

4. Qualifying circumstances

CPT 23155 is performed on patients with a bone cyst or benign tumor of the proximal humerus that requires excision or curettage. The procedure is typically performed by a qualified healthcare professional who is experienced in bone surgeries. The use of autograft, which is bone graft material taken from the patient’s own body, is a qualifying circumstance for this procedure.

5. When to use CPT code 23155

CPT code 23155 should be used when a bone cyst or benign tumor of the proximal humerus is excised or curetted, and an autograft is used to fill the defect. It is important to ensure that the documentation supports the use of autograft and specifies the location from which the graft was obtained.

6. Documentation requirements

To support a claim for CPT 23155, the healthcare professional must document the following information:

• Patient’s diagnosis of a bone cyst or benign tumor of the proximal humerus
• Procedure details, including the use of autograft and the location from which the graft was obtained
• Date of the procedure
• Start and end time of the procedure
• Any complications or additional procedures performed
• Signature of the healthcare professional performing the procedure

7. Billing guidelines

When billing for CPT 23155, ensure that the procedure meets the criteria for excision or curettage of a bone cyst or benign tumor of the proximal humerus with autograft. It is important to document the use of autograft and the location from which the graft was obtained. If allograft (bone graft taken from someone other than the patient) is used instead of autograft, report a different CPT code. It is also important to follow any specific billing guidelines provided by the payer.

8. Historical information

CPT code 23155 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 23155

Five similar codes to CPT 23155 include:

• CPT 23156: Excision or curettage of bone cyst or benign tumor of proximal humerus with allograft
• CPT 23170: Excision or curettage of bone cyst or benign tumor of distal humerus
• CPT 23172: Excision or curettage of bone cyst or benign tumor of proximal radius or ulna
• CPT 23174: Excision or curettage of bone cyst or benign tumor of distal radius or ulna
• CPT 23180: Excision or curettage of bone cyst or benign tumor of proximal fibula

9. Examples

1. A patient undergoes excision of a bone cyst in the proximal humerus with autograft.
2. A provider performs curettage of a benign tumor in the proximal humerus and fills the defect with autograft.
3. An individual undergoes excision of a bone cyst in the proximal humerus with autograft obtained from the iliac crest.
4. A healthcare professional performs curettage of a benign tumor in the proximal humerus and uses autograft to fill the defect.
5. A patient undergoes excision of a bone cyst in the proximal humerus with autograft obtained from another location in their body.
6. A provider performs curettage of a benign tumor in the proximal humerus and fills the defect with autograft harvested from the patient.
7. An individual undergoes excision of a bone cyst in the proximal humerus with autograft obtained from the patient’s own body.
8. A healthcare professional performs curettage of a benign tumor in the proximal humerus and uses autograft taken from another location in the patient’s body to fill the defect.
9. A patient undergoes excision of a bone cyst in the proximal humerus with autograft obtained from the iliac crest.
10. A provider performs curettage of a benign tumor in the proximal humerus and fills the defect with autograft taken from another location in the patient’s body.