How To Use CPT Code 23466

CPT code 23466 describes a surgical procedure known as capsulorrhaphy for the glenohumeral 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 23466?

CPT code 23466 is used to describe a surgical procedure called capsulorrhaphy for the glenohumeral joint. This procedure involves repairing a tear in the shoulder joint capsule and tightening the joint capsule in cases of hyperlaxity, which is an excessive movement in an abnormal plane of movement for the shoulder. The purpose of this procedure is to treat multidirectional instability of the shoulder.

2. Official Description

The official description of CPT code 23466 is: ‘Capsulorrhaphy, glenohumeral joint, any type multidirectional instability.’

3. Procedure

In the capsulorrhaphy procedure, the healthcare provider repairs a tear in the shoulder joint capsule and tightens the joint capsule to address hyperlaxity and multidirectional instability of the shoulder. The procedure typically involves the following steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider makes an incision over the shoulder joint and dissects through the subcutaneous tissue to expose the joint capsule.
3. The upper and lower borders of the subscapularis tendon are visualized.
4. The provider transects the subscapularis tendon down to the capsule and separates it from the capsule.
5. The provider explores and assesses the capsule, removing any loose bodies from the joint cavity.
6. If a labral tear is present, the provider repairs it by suturing the labrum to the glenoid.
7. A T-shaped opening is made in the capsule, creating superior (upper) and inferior (lower) flaps.
8. The inferior capsule flap is pulled superiorly and sutured to the stump of the subscapular tendon and the remains of the humeral capsule, reducing posterior capsular redundancy.
9. The superior flap is then drawn down over the inferior flap and sutured down the arm.
10. The subscapular tendon is reattached to its normal location.
11. All bleeding is stopped, and the wound is closed by suturing the layers of tissue together.
12. A sling is placed on the shoulder for four to six weeks to aid in healing.

4. Qualifying circumstances

CPT code 23466 is used for patients with multidirectional instability of the shoulder, which causes dislocation or instability. The procedure is performed by a healthcare provider to repair a tear in the joint capsule and tighten the capsule to address hyperlaxity. The patient must meet the criteria for multidirectional instability, and the procedure must be medically necessary.

5. When to use CPT code 23466

CPT code 23466 should be used when a healthcare provider performs a capsulorrhaphy procedure for the glenohumeral joint to address multidirectional instability and hyperlaxity. It is important to ensure that the procedure is medically necessary and meets the criteria for multidirectional instability.

6. Documentation requirements

To support a claim for CPT code 23466, the healthcare provider must document the following information:

• Patient’s diagnosis of multidirectional instability
• Description of the tear in the joint capsule
• Details of the procedure performed, including any repairs made to the labrum
• Date of the procedure
• Start and end time of the procedure
• Any complications or unexpected findings during the procedure
• Post-operative care instructions
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT code 23466, ensure that the procedure meets the criteria for multidirectional instability and hyperlaxity. It is important to follow the specific documentation requirements and guidelines provided by the payer. Additionally, consider any applicable modifiers or additional codes that may be necessary to accurately report the procedure.

8. Historical information

CPT code 23466 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 23466

There are several similar codes to CPT code 23466 that are used to describe other repair, revision, and/or reconstruction procedures on the shoulder. Some similar codes include:

• CPT 23395: Repair of shoulder dislocation, open, with or without capsular repair
• CPT 23410: Arthroplasty, glenohumeral joint; hemiarthroplasty
• CPT 23412: Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement) (excluding hemiarthroplasty)
• CPT 23420: Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement) (including hemiarthroplasty)
• CPT 23430: Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement) (including hemiarthroplasty)

9. Examples

1. A patient with multidirectional instability undergoes a capsulorrhaphy procedure to repair a tear in the shoulder joint capsule and tighten the capsule to address hyperlaxity.
2. A healthcare provider performs a capsulorrhaphy procedure on a patient with recurrent shoulder dislocations to stabilize the joint and prevent further dislocations.
3. A patient with hyperlaxity and multidirectional instability of the shoulder undergoes a capsulorrhaphy procedure to improve joint stability and reduce the risk of dislocations.
4. A healthcare provider performs a capsulorrhaphy procedure on a patient with chronic shoulder instability to repair a tear in the joint capsule and tighten the capsule for improved stability.
5. A patient with multidirectional instability and hyperlaxity of the shoulder undergoes a capsulorrhaphy procedure to address recurrent dislocations and improve joint stability.