How To Use CPT Code 23585

CPT code 23585 describes the open treatment of a scapular fracture, specifically involving the body, glenoid, or acromion. 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 23585?

CPT 23585 is used to describe the open treatment of a scapular fracture, which involves the body, glenoid, or acromion of the scapula. This code is used when a provider performs a surgical procedure to repair the fracture, which may include the use of screws or a metal plate to stabilize the fracture until it heals.

2. Official Description

The official description of CPT code 23585 is: ‘Open treatment of scapular fracture (body, glenoid or acromion) includes internal fixation, when performed.’

3. Procedure

During the procedure for CPT 23585, the provider begins by preparing and anesthetizing the patient. They then make an incision over the fracture site and dissect down to the bone. The provider carefully repositions the bone fragments into their normal anatomical alignment, a process known as reduction. If necessary, the provider may use screws or a metal plate to hold the bone fragments in place until healing occurs. After ensuring there is no excessive bleeding, the area is irrigated and the incision is closed.

4. Qualifying circumstances

Patients who qualify for CPT 23585 are those who have a scapular fracture involving the body, glenoid, or acromion. The procedure is performed by a provider who is skilled in open treatment of fractures and is capable of performing internal fixation if necessary. The decision to use CPT 23585 is based on the specific fracture and the provider’s clinical judgment.

5. When to use CPT code 23585

CPT code 23585 should be used when a provider performs open treatment of a scapular fracture involving the body, glenoid, or acromion. This code is appropriate when the provider performs internal fixation as part of the procedure. It is important to note that CPT code 23585 should not be used for fractures in other areas of the scapula or for different types of fractures.

6. Documentation requirements

To support a claim for CPT 23585, the provider must document the following information:

• Patient’s diagnosis of a scapular fracture involving the body, glenoid, or acromion
• Description of the procedure performed, including any internal fixation used
• Date of the procedure
• Details of the reduction process, including any challenges or complications
• Any additional procedures performed during the same session
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 23585, it is important to ensure that the procedure meets the criteria outlined in the code description. The provider must perform open treatment of a scapular fracture involving the body, glenoid, or acromion, and internal fixation must be performed if necessary. It is also important to follow any additional guidelines provided by the payer or coding guidelines.

8. Historical information

CPT code 23585 was added to the Current Procedural Terminology system on January 1, 1990. On January 1, 2009, the code description was updated to include the option of performing the procedure with or without internal fixation.

9. Similar codes to CPT 23585

There are several similar codes to CPT 23585 that describe different procedures for scapular fractures. These include:

• CPT 23575: Open treatment of scapular fracture, glenoid fossa of shoulder
• CPT 23580: Open treatment of scapular fracture, acromion
• CPT 23586: Open treatment of scapular fracture, glenoid neck
• CPT 23590: Open treatment of scapular fracture, coracoid process
• CPT 23595: Open treatment of scapular fracture, spine of scapula

9. Examples

1. A patient sustains a scapular fracture involving the glenoid during a fall. The provider performs open treatment of the fracture, including internal fixation with screws.
2. A patient is involved in a car accident and fractures their scapular body. The provider performs open treatment of the fracture, using a metal plate to stabilize the bone fragments.
3. A patient presents with a scapular fracture involving the acromion after a sports injury. The provider performs open treatment of the fracture, repositioning the bone fragments and securing them with screws.
4. A patient fractures their scapula at the glenoid neck during a fall. The provider performs open treatment of the fracture, using internal fixation to stabilize the bone fragments.
5. A patient sustains a scapular fracture involving the coracoid process in a bicycle accident. The provider performs open treatment of the fracture, repositioning the bone fragments and securing them with screws.