How To Use CPT Code 23491

CPT code 23491 describes the prophylactic treatment of a defect in the upper end of the humerus bone using fixation implants such as nails, plates, or screws, with or without the use of methylmethacrylate. 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 23491?

CPT code 23491 is used to describe the prophylactic treatment of a defect in the upper end of the humerus bone. The procedure involves the use of fixation implants, such as nails, plates, or screws, to stabilize the bone and prevent further problems. The use of methylmethacrylate, a type of bone cement, may also be employed for additional stability.

2. Official Description

The official description of CPT code 23491 is: ‘Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate proximal humerus.’

3. Procedure

During the procedure, the healthcare provider makes an incision just above the defect in the upper end of the humerus bone. They then dissect through the subcutaneous tissue to reach the bone. The nerve and muscle tissue in the area are carefully retracted. Fixation implants, such as nails, pins, plates, or wires, are used to fix the defect in the bone and stabilize it. The provider may also use methylmethacrylate, a type of bone cement, to fill the defect and provide additional stability. Any bleeding at the surgical site is controlled, and the wound is closed by suturing the soft tissue in layers.

4. Qualifying circumstances

CPT code 23491 is used for patients who require prophylactic treatment of a defect in the upper end of the humerus bone. This may be necessary to prevent further problems or complications. The procedure is performed by a healthcare provider who is appropriately trained and qualified to perform the treatment. The use of fixation implants, such as nails, plates, or screws, is a key component of this procedure.

5. When to use CPT code 23491

CPT code 23491 should be used when a patient requires prophylactic treatment for a defect in the upper end of the humerus bone. This code is appropriate when fixation implants, such as nails, plates, or screws, are used to stabilize the bone. The use of methylmethacrylate may also be included in this procedure. It is important to ensure that the documentation supports the necessity of the prophylactic treatment and the specific techniques used.

6. Documentation requirements

To support a claim for CPT code 23491, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for prophylactic treatment
• Specific fixation implants used, such as nails, plates, or screws
• Use of methylmethacrylate, if applicable
• Date of the procedure
• Details of the surgical technique, including any X-rays taken for verification
• Any additional procedures performed during the same session
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT code 23491, it is important to ensure that the procedure meets the criteria outlined in the official description. The use of fixation implants, such as nails, plates, or screws, is a key component of this code. If methylmethacrylate is used, it should be documented and billed accordingly. It is also important to follow any specific billing guidelines provided by the payer or coding guidelines.

8. Historical information

CPT code 23491 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 23491

Five similar codes to CPT 23491 include:

• CPT 23395: Repair of the shoulder joint, including the rotator cuff, labrum, and ligaments
• CPT 23410: Treatment of a fracture of the proximal humerus, including open reduction and internal fixation
• CPT 23412: Treatment of a fracture of the proximal humerus, including open reduction and internal fixation with prosthetic replacement
• CPT 23420: Treatment of a fracture of the proximal humerus, including closed reduction and percutaneous fixation
• CPT 23430: Treatment of a fracture of the proximal humerus, including closed reduction and percutaneous fixation with prosthetic replacement

9. Examples

1. A patient with a defect in the upper end of the humerus bone undergoes prophylactic treatment using fixation implants, such as plates and screws, to stabilize the bone.
2. A healthcare provider performs prophylactic treatment on a patient’s upper end of the humerus bone using nails and methylmethacrylate for additional stability.
3. Prophylactic treatment is performed on a patient’s upper end of the humerus bone using wires and plates to prevent further problems.
4. A healthcare provider uses fixation implants, such as screws and plates, to stabilize a defect in the upper end of a patient’s humerus bone.
5. Prophylactic treatment is performed on a patient’s upper end of the humerus bone using nails and methylmethacrylate for additional stability.
6. A healthcare provider performs prophylactic treatment on a patient’s upper end of the humerus bone using wires and plates to prevent further problems.
7. A patient undergoes prophylactic treatment for a defect in the upper end of the humerus bone using fixation implants, such as screws and plates, to stabilize the bone.
8. Prophylactic treatment is performed on a patient’s upper end of the humerus bone using nails and methylmethacrylate for additional stability.
9. A healthcare provider uses fixation implants, such as wires and plates, to stabilize a defect in the upper end of a patient’s humerus bone.
10. Prophylactic treatment is performed on a patient’s upper end of the humerus bone using nails and methylmethacrylate for additional stability.