How To Use CPT Code 23395

CPT code 23395 describes the procedure of muscle transfer in the shoulder or upper arm. 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 23395?

CPT 23395 is a code used to describe the transfer of a muscle from another location of the patient’s body to the shoulder or upper arm. This procedure is performed to treat injuries that impair the function of the upper extremity due to damage of the muscle in the upper arm or shoulder.

2. Official Description

The official description of CPT code 23395 is: ‘Muscle transfer, any type, shoulder or upper arm single.’

3. Procedure

During the procedure, the healthcare provider prepares the patient by ensuring they are appropriately prepped and anesthetized. The provider then dissects a donor muscle, such as the gracilis muscle in the patient’s thigh, and prepares the recipient site in the shoulder or upper arm to receive the donor muscle transfer. The provider brings the donor muscle to the arm and positions it within the recipient site. The muscle is fixed into place by suturing one end to the remaining end of the damaged muscle and the other end to the bone. The site is irrigated, bleeding is stopped, and the wounds are closed by suturing the layers of tissue together.

4. Qualifying circumstances

CPT 23395 is performed on patients who have injuries or damage to the muscles in the upper arm or shoulder that impair the function of the upper extremity. The procedure involves transferring a muscle from another location of the patient’s body to the affected area. The patient must meet the criteria for the procedure, and the healthcare provider must determine that muscle transfer is the appropriate treatment option.

5. When to use CPT code 23395

CPT code 23395 should be used when a muscle transfer procedure is performed on the shoulder or upper arm. It is important to ensure that the procedure meets the specific criteria outlined in the code description. If multiple muscle transfers are performed in the same area, a different code, such as CPT code 23397, should be used.

6. Documentation requirements

To support a claim for CPT code 23395, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for muscle transfer
• Details of the procedure, including the specific muscle transferred and the recipient site
• Date of the procedure
• Start and end time of the procedure
• Any complications or additional procedures performed
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT code 23395, ensure that the procedure meets the criteria outlined in the code description. It is important to follow the specific guidelines for reporting this code and any associated codes. If multiple muscle transfers are performed, a different code should be used. It is also important to consider any modifiers that may be required for accurate billing.

8. Historical information

CPT code 23395 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 23395

There are several similar codes to CPT 23395 that describe muscle transfers in the shoulder or upper arm. These include:

• CPT 23397: Muscle transfer, any type, shoulder or upper arm multiple
• Other similar codes may exist, but they are not provided in the available information.

9. Examples

1. A patient with a severe rotator cuff tear undergoes a muscle transfer procedure to restore function in the shoulder.
2. An individual who sustained a traumatic injury to the upper arm receives a muscle transfer to improve arm movement and strength.
3. A patient with a brachial plexus injury undergoes a muscle transfer procedure to restore function in the affected arm.
4. An individual with a chronic shoulder dislocation undergoes a muscle transfer to stabilize the joint and prevent further dislocations.
5. A patient with a muscle atrophy in the upper arm receives a muscle transfer to improve muscle strength and function.
6. An individual with a congenital muscle deficiency undergoes a muscle transfer procedure to enhance upper arm function.
7. A patient with a muscle tear in the shoulder undergoes a muscle transfer to repair the damaged muscle and restore function.
8. An individual with a nerve injury in the upper arm receives a muscle transfer to compensate for the loss of muscle function.
9. A patient with a muscle imbalance in the shoulder undergoes a muscle transfer to improve shoulder stability and function.
10. An individual with a muscle degeneration disease undergoes a muscle transfer procedure to slow down the progression of muscle weakness.