How To Use CPT Code 23190

CPT code 23190 describes the partial ostectomy of the scapula, specifically the superior medial angle. 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 23190?

CPT 23190 is a code used to describe the partial ostectomy of the scapula, specifically the superior medial angle. This procedure involves the removal of a portion of the shoulder blade to treat conditions such as infection, tumor, or deformity.

2. Official Description

The official description of CPT code 23190 is: ‘Ostectomy of scapula, partial (eg, superior medial angle).’ This procedure involves the surgical removal of a portion of the scapula, specifically the topmost angle nearest the ribs.

3. Procedure

During the procedure, the patient is appropriately prepped and anesthetized. The provider makes an incision over the superior medial angle of the scapula. The underlying muscles, especially the trapezius muscle, are dissected. Bone cutting instruments are then used to excise the bone, and the area is smoothed with a bone rasp. In the presence of infection, the area is irrigated with antibiotic solution and a drain may be inserted. The provider checks for bleeding, removes any instruments, and closes the incision.

4. Qualifying circumstances

CPT 23190 is typically performed on patients with conditions such as infection, tumor, or deformity of the scapula. The procedure is indicated when other treatment options have been exhausted or are not appropriate. Preauthorization is recommended for this code, as carriers may have specific requirements regarding which diagnosis codes they will reimburse for this procedure.

5. When to use CPT code 23190

CPT code 23190 should be used when a partial ostectomy of the scapula, specifically the superior medial angle, is performed. It is important to ensure that the procedure is medically necessary and appropriate for the patient’s condition. This code should not be used for complete ostectomy of the scapula or for other areas of the scapula.

6. Documentation requirements

To support a claim for CPT code 23190, the provider must document the following information:

• Patient’s diagnosis and the medical necessity of the procedure
• Specific details of the procedure, including the location of the ostectomy (superior medial angle)
• Date of the procedure
• Incision details and closure method
• Any additional procedures performed during the same session
• Any complications or unexpected findings
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 23190, it is important to ensure that the procedure performed matches the description of the code. This code should not be reported with other codes unless additional procedures were performed during the same session. Preauthorization is recommended due to potential variations in reimbursement requirements among carriers.

8. Historical information

CPT code 23190 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 23190

There are several similar codes to CPT code 23190 that describe other excision procedures on the shoulder. These include:

• CPT 23065: Excision, tumor, soft tissue of shoulder area; subcutaneous
• CPT 23100: Excision, tumor, soft tissue of shoulder area; subfascial (eg, intramuscular)
• CPT 23101: Excision, tumor, soft tissue of shoulder area; deep, subfascial (eg, intramuscular)
• CPT 23105: Excision, tumor, soft tissue of shoulder area; deep, intracapsular
• CPT 23220: Excision, tumor, soft tissue of shoulder area; deep, extracapsular

9. Examples

1. A patient undergoes a partial ostectomy of the superior medial angle of the scapula to treat an infection.
2. A provider performs a partial ostectomy of the scapula to remove a tumor located at the superior medial angle.
3. A patient with a scapular deformity undergoes a partial ostectomy of the superior medial angle to correct the deformity.
4. A provider performs a partial ostectomy of the scapula to remove a benign tumor located at the superior medial angle.
5. A patient with a scapular infection undergoes a partial ostectomy of the superior medial angle to treat the infection.
6. A provider performs a partial ostectomy of the scapula to remove a malignant tumor located at the superior medial angle.
7. A patient with a scapular deformity undergoes a partial ostectomy of the superior medial angle to improve shoulder function.
8. A provider performs a partial ostectomy of the scapula to remove a tumor that is causing pain and limited range of motion.
9. A patient with a scapular infection undergoes a partial ostectomy of the superior medial angle to prevent further spread of the infection.
10. A provider performs a partial ostectomy of the scapula to remove a tumor that is pressing on nearby nerves and causing symptoms.