How To Use CPT Code 23195

CPT code 23195 describes the resection of the humeral head, which involves the removal of the rounded portion of the upper arm bone where it connects to the shoulder 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 23195?

CPT code 23195 is used to describe the resection of the humeral head, which involves the removal of the rounded portion of the upper arm bone where it connects to the shoulder joint. This procedure is typically performed to treat conditions such as osteomyelitis, necrotic bone, or tumors in the area.

2. Official Description

The official description of CPT code 23195 is: ‘Resection, humeral head (For replacement with implant, use 23470).’ This code specifically refers to the removal of the humeral head without the use of an implant. If an implant is used to replace the humeral head, a different code, 23470, should be used.

3. Procedure

During the resection of the humeral head, the patient is appropriately prepped and anesthetized. The provider makes an incision in the upper arm and dissects the muscles and tissues to gain access to the head of the humerus. Using bone piercing tools, the provider excises the head of the humerus. A drainage tube may be inserted, and the area is irrigated with antibiotics. The provider checks for bleeding, removes any instruments, and closes the incision.

4. Qualifying circumstances

CPT code 23195 is typically performed when a patient has conditions such as osteomyelitis, necrotic bone, or tumors in the humeral head. The procedure is performed by a qualified healthcare professional who is trained in performing surgical interventions on the shoulder joint.

5. When to use CPT code 23195

CPT code 23195 should be used when the provider performs a resection of the humeral head without the use of an implant. If an implant is used to replace the humeral head, a different code, 23470, should be used instead.

6. Documentation requirements

To support a claim for CPT code 23195, the healthcare professional must document the following information:

• Patient’s diagnosis necessitating the resection of the humeral head
• Description of the procedure performed, including the specific techniques used
• Date of the procedure
• Any complications or unexpected findings during the procedure
• Post-operative care instructions, if applicable
• Signature of the healthcare professional performing the procedure

7. Billing guidelines

When billing for CPT code 23195, ensure that the procedure performed is a resection of the humeral head without the use of an implant. If an implant is used, a different code, 23470, should be used instead. It is important to follow the specific guidelines provided by the payer to ensure accurate and appropriate billing.

8. Historical information

CPT code 23195 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 23195

There are several similar codes to CPT code 23195 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; subfascial (eg, intramuscular)
• CPT 23067: Excision, tumor, soft tissue of shoulder area; deep, subfascial (eg, intramuscular)
• CPT 23100: Excision, tumor, soft tissue of shoulder area; superficial
• CPT 23220: Excision, tumor, soft tissue of shoulder area; deep, subfascial (eg, intramuscular)

9. Examples

1. A patient with osteomyelitis in the humeral head undergoes a resection procedure to remove the infected bone.
2. A patient with a necrotic humeral head due to avascular necrosis undergoes a resection procedure to remove the dead bone tissue.
3. A patient with a tumor in the humeral head undergoes a resection procedure to remove the cancerous growth.
4. A patient with a traumatic injury to the humeral head undergoes a resection procedure to repair the damaged bone.
5. A patient with a non-healing fracture in the humeral head undergoes a resection procedure to promote bone healing.
6. A patient with a bone infection in the humeral head undergoes a resection procedure to remove the infected tissue.
7. A patient with a benign tumor in the humeral head undergoes a resection procedure to remove the abnormal growth.
8. A patient with a cyst in the humeral head undergoes a resection procedure to remove the fluid-filled sac.
9. A patient with a bone metastasis in the humeral head undergoes a resection procedure to remove the cancerous lesion.
10. A patient with a bone infarction in the humeral head undergoes a resection procedure to remove the dead bone tissue.