How To Use CPT Code 23420

CPT code 23420 describes the reconstruction of a complete shoulder (rotator) cuff avulsion in patients with chronic rotator cuff tear or rupture. 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 23420?

CPT 23420 is used to describe the reconstruction of a complete shoulder (rotator) cuff avulsion in patients with chronic rotator cuff tear or rupture. This procedure involves repairing the torn rotator cuff muscle and performing an acromioplasty, which involves shaving a portion of bone from the underside of the acromion process to relieve pressure on underlying muscles or tendons.

2. Official Description

The official description of CPT code 23420 is: ‘Reconstruction of complete shoulder (rotator) cuff avulsion, chronic (includes acromioplasty).’

3. Procedure

During the procedure, the healthcare provider makes an incision across the front of the shoulder, from the middle of the collarbone to the middle of the arm bone. They then dissect down through the subcutaneous tissue to access the joint. The provider releases the deltoid muscle from the acromion process and preserves the bony attachment for later reattachment. The torn rotator cuff muscle is exposed and assessed for the shape and extent of the tear. The provider repairs the rotator cuff muscle using multiple sutures and fixes it to the bone with anchors. If necessary, an acromioplasty is performed by shaving off a portion of the bone from the underside of the acromion process. The provider then repairs the deltoid muscle and closes the wound with sutures.

4. Qualifying circumstances

CPT 23420 is performed on patients with chronic rotator cuff tear or rupture. The procedure is indicated when conservative treatments have failed to provide relief and the patient continues to experience pain and limited shoulder function. The patient must have a documented diagnosis of chronic rotator cuff tear or rupture, and the procedure must be performed by a qualified healthcare provider.

5. When to use CPT code 23420

CPT code 23420 should be used when a patient with chronic rotator cuff tear or rupture undergoes a complete shoulder reconstruction, including an acromioplasty. This code should not be used for other shoulder procedures or for acute rotator cuff tears. It is important to accurately document the patient’s condition and the specific procedure performed to support the use of CPT code 23420.

6. Documentation requirements

To support a claim for CPT code 23420, the healthcare provider must document the following information:

• Patient’s diagnosis of chronic rotator cuff tear or rupture
• Description of the tear or rupture, including its shape and extent
• Details of the reconstruction procedure, including the use of sutures and anchors
• Description of the acromioplasty procedure, if performed
• Date of the procedure
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT code 23420, ensure that the procedure meets the criteria for chronic rotator cuff tear or rupture and includes the reconstruction of the complete shoulder cuff avulsion and acromioplasty. It is important to accurately document the procedure and provide the necessary supporting documentation. CPT code 23420 should not be reported with other shoulder procedures unless they are distinct and separate from the reconstruction of the complete shoulder cuff avulsion.

8. Historical information

CPT code 23420 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 23420

Five similar codes to CPT 23420 include:

• CPT 23410: Reconstruction of partial shoulder (rotator) cuff avulsion, chronic (includes acromioplasty)
• CPT 23412: Reconstruction of complete shoulder (rotator) cuff avulsion, acute (includes acromioplasty)
• CPT 23430: Reconstruction of shoulder (rotator) cuff avulsion, acute or chronic, with prosthetic replacement of the humeral head
• CPT 23440: Reconstruction of shoulder (rotator) cuff avulsion, acute or chronic, with prosthetic replacement of the humeral head and glenoid
• CPT 23445: Reconstruction of shoulder (rotator) cuff avulsion, acute or chronic, with prosthetic replacement of the humeral head, glenoid, and proximal humeral shaft (reverse total shoulder arthroplasty)

9. Examples

1. A patient with chronic rotator cuff tear undergoes a complete shoulder reconstruction with acromioplasty.
2. A healthcare provider performs a reconstruction of a complete shoulder cuff avulsion with acromioplasty in a patient with chronic rotator cuff rupture.
3. A patient with chronic rotator cuff tear and avulsion undergoes a surgical procedure to reconstruct the complete shoulder and perform an acromioplasty.
4. A healthcare provider performs a complete shoulder reconstruction with acromioplasty in a patient with chronic rotator cuff tear and avulsion.
5. A patient with chronic rotator cuff rupture undergoes a surgical procedure to repair the complete shoulder cuff avulsion and perform an acromioplasty.
6. A healthcare provider performs a reconstruction of a complete shoulder cuff avulsion with acromioplasty in a patient with chronic rotator cuff tear.
7. A patient with chronic rotator cuff tear and avulsion undergoes a complete shoulder reconstruction and acromioplasty procedure.
8. A healthcare provider performs a complete shoulder reconstruction with acromioplasty in a patient with chronic rotator cuff rupture and avulsion.
9. A patient with chronic rotator cuff rupture undergoes a surgical procedure to repair the complete shoulder cuff avulsion and perform an acromioplasty.
10. A healthcare provider performs a reconstruction of a complete shoulder cuff avulsion with acromioplasty in a patient with chronic rotator cuff tear and avulsion.