How To Use CPT Code 23474

CPT 23474 refers to the revision of total shoulder arthroplasty, a surgical procedure aimed at correcting issues related to previously implanted shoulder prostheses. This procedure is critical for patients experiencing complications such as loosening or damage to the artificial components of the shoulder joint. The revision involves the careful removal and replacement of both the humeral and glenoid components, and may include the use of an allograft to ensure proper fit and stability of the new prosthesis. This intervention is essential to prevent further joint deterioration and to restore function and mobility to the affected shoulder.

1. What is CPT code 23474?

CPT code 23474 represents a surgical procedure known as revision total shoulder arthroplasty. This procedure is performed when a previously implanted shoulder prosthesis has become loose, damaged, or otherwise dysfunctional. The primary goal of this surgery is to remove the existing components of the shoulder joint—specifically the humeral and glenoid components—and replace them with new ones. The use of an allograft may be indicated to provide additional support and stability to the new prosthesis. This procedure is clinically relevant as it addresses complications that can arise from total shoulder arthroplasty, ensuring that patients can regain optimal shoulder function and alleviate pain associated with joint instability.

2. Qualifying Circumstances

This CPT code can be utilized in specific circumstances where a patient has undergone a total shoulder arthroplasty and is now experiencing complications that necessitate a revision. Indications for using this code include the presence of a loose or damaged prosthesis, significant pain, or loss of function in the shoulder joint. It is important to note that this code is appropriate when both the humeral and glenoid components require revision. However, if only one component is being revised, CPT code 23473 should be used instead. Additionally, the use of an allograft is not mandatory for this procedure, but it may be employed based on the surgeon’s discretion and the specific needs of the patient.

3. When To Use CPT 23474

CPT code 23474 is used when a surgeon performs a comprehensive revision of both the humeral and glenoid components of a total shoulder arthroplasty. This code should be applied when the procedure involves the removal of existing components and the implantation of new ones, with or without the use of an allograft. It is crucial to avoid using this code in conjunction with codes for hemiarthroplasty (23470) or total shoulder arthroplasty (23472), as these codes represent different procedures. The provider must ensure that the clinical scenario aligns with the requirements for this specific code to ensure accurate billing and documentation.

4. Official Description of CPT 23474

Official Descriptor: Revision of total shoulder arthroplasty, including allograft when performed; humeral and glenoid component.

5. Clinical Application

The clinical application of CPT code 23474 is primarily in the context of patients who have undergone total shoulder arthroplasty and are now facing complications that necessitate surgical intervention. The procedure is vital for restoring joint stability and function, as well as alleviating pain associated with a failing prosthesis. The revision process is complex and requires careful planning and execution to ensure the best possible outcomes for the patient. The use of an allograft can enhance the stability of the new components, particularly in cases where bone loss has occurred around the joint.

5.1 Provider Responsibilities

During the procedure, the provider is responsible for several critical steps. Initially, the patient is prepped and anesthetized. The provider then exposes the shoulder joint through the previous incision, carefully dissecting through the subcutaneous tissue to access the joint. Muscles, nerves, and blood vessels are retracted to provide a clear view of the surgical site. The provider removes any granulation tissue and dislodges the existing prosthesis, taking care to eliminate any excess bone cement. The bone is then incised to prepare for the new prosthesis, and an allograft may be utilized to secure the new components. Finally, the provider ensures hemostasis, sutures the tissue in layers, and may place a drain to facilitate healing.

5.2 Unique Challenges

One of the unique challenges associated with this procedure is the potential for complications arising from the previous surgery, such as scar tissue formation or bone loss. These factors can complicate the dissection and removal of the old components. Additionally, the provider must carefully assess the integrity of the surrounding tissues and bone to ensure that the new prosthesis can be securely implanted. The use of an allograft also introduces considerations regarding graft compatibility and the potential for rejection or complications related to the graft.

5.3 Pre-Procedure Preparations

Before the procedure, the provider must conduct a thorough evaluation of the patient’s medical history, imaging studies, and physical examination to assess the condition of the shoulder joint. This may include X-rays or MRI scans to evaluate the status of the existing prosthesis and surrounding bone. The provider must also ensure that the patient is in optimal health for surgery, which may involve preoperative lab tests and consultations with other specialists if necessary.

5.4 Post-Procedure Considerations

After the procedure, the patient requires careful monitoring for signs of complications such as infection, bleeding, or issues related to the allograft. Pain management and rehabilitation are crucial components of post-operative care to facilitate recovery and restore function. The provider may schedule follow-up appointments to assess the healing process and the performance of the new prosthesis, ensuring that the patient is progressing as expected.

6. Relevant Terminology

Allograft: The transfer of tissue from one individual to another, often used to support surgical repairs.

Arthroplasty: A surgical procedure aimed at repairing or replacing a joint.

Glenoid cavity: The hollow socket in the shoulder blade that articulates with the humeral head to form the shoulder joint.

Glenohumeral joint: The ball-and-socket joint formed by the head of the humerus and the glenoid cavity, commonly referred to as the shoulder joint.

Granulation tissue: A type of connective tissue that forms during the healing process at the site of injury.

Hemiarthroplasty: A surgical procedure that replaces one surface of a joint with an artificial implant.

Humerus: The long bone in the upper arm that connects the shoulder to the elbow.

Prosthesis: An artificial device used to replace a missing body part, such as a joint.

Revision arthroplasty: A surgical procedure that involves removing and replacing a previously implanted artificial joint.

7. Clinical Examples

1. A 65-year-old patient presents with persistent pain and instability in the shoulder joint following a total shoulder arthroplasty performed five years ago. Imaging reveals loosening of both the humeral and glenoid components, necessitating a revision procedure.

2. A 72-year-old female patient experiences decreased range of motion and discomfort in her shoulder after a previous arthroplasty. Upon evaluation, the surgeon determines that both components require replacement due to wear and tear.

3. A 58-year-old male patient with a history of shoulder surgery presents with swelling and tenderness around the joint. Surgical intervention is required to revise the components and address the complications.

4. A patient who underwent total shoulder arthroplasty two years ago reports severe pain and instability. The surgeon decides to perform a revision using an allograft to enhance the stability of the new prosthesis.

5. A 70-year-old patient with a history of rheumatoid arthritis presents with joint deterioration. The surgeon recommends a revision of the total shoulder arthroplasty to improve function and reduce pain.

6. A 64-year-old female patient experiences complications from a previous shoulder surgery. The provider assesses the need for a revision of both the humeral and glenoid components to restore joint function.

7. A 75-year-old male patient with a history of shoulder pain undergoes imaging that reveals loosening of the prosthesis. The surgeon plans a revision procedure to replace both components.

8. A patient presents with chronic pain and limited mobility in the shoulder joint after a total shoulder arthroplasty. The surgical team determines that a revision is necessary to address the issues.

9. A 68-year-old patient reports discomfort and instability in the shoulder joint. The provider evaluates the need for a revision of the total shoulder arthroplasty to improve the patient’s quality of life.

10. A patient with a previous shoulder arthroplasty experiences complications due to infection. The surgical team decides to perform a revision to remove the infected components and replace them with new ones.