How To Use CPT Code 23156

CPT code 23156 describes the excision or curettage of a bone cyst or benign tumor of the proximal humerus with the use of allograft. 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 23156?

CPT 23156 is used to describe the surgical procedure of removing a bone cyst or benign tumor from the proximal humerus, which is the upper part of the bone in the arm. During this procedure, the provider uses a cutting or scraping instrument to excise the mass and then fills the resulting defect with allograft, which is donor bone graft. The specimen is sent to a laboratory for analysis to confirm its nature.

2. Official Description

The official description of CPT code 23156 is: ‘Excision or curettage of bone cyst or benign tumor of proximal humerus with allograft.’

3. Procedure

The procedure for CPT code 23156 involves the following steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider makes an incision in the upper arm over the area of the mass.
3. The provider dissects down to the level of the bone and opens the periosteum, which is the membrane covering the bone.
4. Using an osteotome or bone curette, the provider excises the mass down to healthy tissue.
5. The excised specimen is sent to a laboratory for analysis.
6. The provider applies allograft to fill the defect.
7. The area is irrigated, checked for bleeding, and all instruments are removed.
8. All incisions are closed.

4. Qualifying circumstances

CPT code 23156 is used for patients who require the excision or curettage of a bone cyst or benign tumor in the proximal humerus. The procedure must involve the use of allograft to fill the defect. It is important to note that if the provider uses autograft, which is bone graft taken from the patient’s own body, a different CPT code should be used (23155).

5. When to use CPT code 23156

CPT code 23156 should be used when a provider performs the excision or curettage of a bone cyst or benign tumor in the proximal humerus and fills the defect with allograft. It is important to ensure that the procedure meets the specific criteria outlined in the code description.

6. Documentation requirements

To support a claim for CPT code 23156, the provider must document the following information:

• Patient’s diagnosis indicating the presence of a bone cyst or benign tumor in the proximal humerus
• Details of the procedure performed, including the use of allograft
• Date of the procedure
• Start and end time of the procedure
• Any additional relevant information, such as the size or location of the cyst or tumor
• Results of the laboratory analysis, if available

7. Billing guidelines

When billing for CPT code 23156, it is important to ensure that the procedure meets the specific criteria outlined in the code description. If the provider uses autograft instead of allograft, a different CPT code should be used (23155). It is also important to follow any additional guidelines provided by the payer or relevant coding guidelines.

8. Historical information

CPT code 23156 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 code 23156

There are several similar codes to CPT code 23156 that describe excision procedures on the shoulder. These include:

• CPT 23065: Excision of tumor, soft tissue of shoulder area, subcutaneous; less than 3 cm
• CPT 23066: Excision of tumor, soft tissue of shoulder area, subcutaneous; 3 cm or greater
• CPT 23075: Excision of tumor, soft tissue of shoulder area, deep (subfascial)
• CPT 23120: Excision of tumor, bone; humerus
• CPT 23220: Excision of tumor, bone; scapula or clavicle

9. Examples

1. A patient undergoes excision of a bone cyst in the proximal humerus with allograft.
2. A provider performs curettage of a benign tumor in the proximal humerus and fills the defect with allograft.
3. An individual undergoes excision of a bone cyst in the proximal humerus with allograft, and the specimen is sent to a laboratory for analysis.
4. A provider performs curettage of a benign tumor in the proximal humerus, fills the defect with allograft, and documents the results of the laboratory analysis.
5. A patient undergoes excision of a bone cyst in the proximal humerus with allograft, and the procedure is documented with details of the size and location of the cyst.
6. A provider performs curettage of a benign tumor in the proximal humerus and fills the defect with allograft, documenting the start and end time of the procedure.
7. An individual undergoes excision of a bone cyst in the proximal humerus with allograft, and the provider notes the use of allograft in the documentation.
8. A provider performs curettage of a benign tumor in the proximal humerus, fills the defect with allograft, and includes the results of the laboratory analysis in the documentation.
9. A patient undergoes excision of a bone cyst in the proximal humerus with allograft, and the procedure is documented with the date of the procedure.
10. A provider performs curettage of a benign tumor in the proximal humerus and fills the defect with allograft, documenting any additional relevant information about the procedure.