How To Use CPT Code 23474

CPT code 23474 describes the revision of total shoulder arthroplasty, including the use of an allograft if performed on the humeral and glenoid components. 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 23474?

CPT code 23474 is used to describe the revision of a total shoulder arthroplasty procedure. This includes the removal and replacement of both the humeral and glenoid components of the shoulder joint. If necessary, the provider may also use an allograft during the procedure. The purpose of this code is to address any issues with a previously implanted prosthesis and replace it to prevent further damage to the joint.

2. Official Description

The official description of CPT code 23474 is: ‘Revision of total shoulder arthroplasty, including allograft when performed humeral and glenoid component.’

3. Procedure

During a revision of total shoulder arthroplasty, the provider performs the following steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider exposes the shoulder joint through the previous skin incision.
3. The provider dissects down through the subcutaneous tissue to access the joint.
4. The muscles, nerves, and blood vessels are retracted to provide better visibility.
5. The provider removes any granulation tissue that may have accumulated over the components.
6. Using a surgical instrument, the provider removes the bone cement covering the glenoid and humeral components and dislodges the joint.
7. Excess cement, if present, is removed from the site.
8. The bone is incised to prepare it for the new prosthesis.
9. If necessary, the provider may use an allograft to fix the new prosthesis in place.
10. Bone cement is used to secure the new components properly.
11. The provider revises both the glenoid and humeral components.
12. Hemostasis is achieved at the surgical site, and the wound is closed by suturing the tissue in layers.
13. A drain may be left in place, if needed.

4. Qualifying circumstances

CPT code 23474 is used for patients who require a revision of a previously implanted total shoulder arthroplasty. This procedure is performed when the prosthesis becomes loose or damaged, causing potential harm to the joint. The provider must perform the revision on both the humeral and glenoid components. If an allograft is used during the procedure, it should be documented accordingly.

5. When to use CPT code 23474

CPT code 23474 should be used when a revision of total shoulder arthroplasty is performed, involving the removal and replacement of both the humeral and glenoid components. This code should not be reported if a prosthesis is being removed and replaced in the same shoulder during the same surgical session, in conjunction with codes 23334 and 23335.

6. Documentation requirements

To support a claim for CPT code 23474, the provider must document the following information:

• Patient’s diagnosis and the need for revision of total shoulder arthroplasty
• Specific details of the procedure, including the use of an allograft if performed
• Date of the surgery
• Start and end time of the procedure
• Any complications or unexpected findings during the surgery
• Details of the components removed and replaced
• Use of bone cement and allograft, if applicable
• Any additional procedures performed during the same surgical session
• Signature of the provider

7. Billing guidelines

When billing for CPT code 23474, ensure that the procedure involves the revision of both the humeral and glenoid components. If a prosthesis is being removed and replaced in the same shoulder during the same surgical session, do not report codes 23473 and 23474 together. It is important to follow the specific guidelines provided by payers and coding authorities for accurate billing and reimbursement.

8. Historical information

CPT code 23474 was added to the Current Procedural Terminology system on January 1, 2013. It was initially included in the Inpatient Only (IPO) list for Medicare, but was later removed in 2021. However, in 2022, it was added back to the IPO list.

9. Similar codes to CPT code 23474

There are several similar codes to CPT code 23474 that are used for different procedures involving the shoulder joint. These include:

• CPT 23470: Arthroplasty, glenohumeral joint hemiarthroplasty
• CPT 23472: Arthroplasty, glenohumeral joint total shoulder, glenoid and proximal humeral replacement
• CPT 23473: Revision of total shoulder arthroplasty, including allograft when performed humeral or glenoid component

9. Examples

1. A patient undergoes a revision of total shoulder arthroplasty, with both the humeral and glenoid components being removed and replaced.
2. A provider performs a revision of total shoulder arthroplasty, using an allograft to fix the new prosthesis in place.
3. During a revision of total shoulder arthroplasty, the provider discovers unexpected complications and addresses them accordingly.
4. A patient requires a revision of total shoulder arthroplasty due to a loose or damaged prosthesis.
5. The provider performs a revision of total shoulder arthroplasty, documenting the specific details of the procedure and components replaced.
6. A revision of total shoulder arthroplasty is performed on a patient who experienced complications with their previous prosthesis.
7. The provider revises both the humeral and glenoid components during a total shoulder arthroplasty revision procedure.