How To Use CPT Code 23605

CPT code 23605 describes the closed treatment of a proximal humeral (surgical or anatomical neck) fracture with manipulation, with or without skeletal traction. 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 23605?

CPT code 23605 is used to describe the closed treatment of a proximal humeral (surgical or anatomical neck) fracture with manipulation, with or without skeletal traction. This code is used when a healthcare provider performs a procedure to adjust or realign the fractured bone in the upper end of the humerus without the need for open surgery.

2. Official Description

The official description of CPT code 23605 is: ‘Closed treatment of proximal humeral (surgical or anatomical neck) fracture with manipulation, with or without skeletal traction.’

3. Procedure

In this procedure, the healthcare provider performs a closed treatment of a surgical or anatomical neck fracture of the upper end of the humerus. The provider adjusts the fractured fragment by exerting a pushing or pulling force on the humerus to reduce or realign the fracture. Skeletal traction may be applied to stabilize and reinforce the break. The provider may also perform a separately reportable X-ray examination of the humerus bone to confirm the reduction of the fracture. After the procedure, the patient is placed in a sling or brace for a period of four to six weeks to aid in healing.

4. Qualifying circumstances

CPT code 23605 is used for patients with a proximal humeral (surgical or anatomical neck) fracture that requires closed treatment with manipulation. The procedure is performed by a healthcare provider and may involve the use of skeletal traction. Open surgery is not necessary for this procedure.

5. When to use CPT code 23605

CPT code 23605 should be used when a healthcare provider performs a closed treatment of a proximal humeral (surgical or anatomical neck) fracture with manipulation, with or without skeletal traction. This code should not be used if the procedure involves open surgery or if manipulation is not performed.

6. Documentation requirements

To support a claim for CPT code 23605, the healthcare provider must document the following information:

• Patient’s diagnosis of a proximal humeral (surgical or anatomical neck) fracture
• Description of the closed treatment procedure performed, including manipulation and use of skeletal traction if applicable
• Date of the procedure
• Confirmation of reduction of the fracture through a separately reportable X-ray examination
• Details of any additional procedures or services provided
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT code 23605, ensure that the procedure meets the criteria for closed treatment of a proximal humeral (surgical or anatomical neck) fracture with manipulation, with or without skeletal traction. This code should not be reported if the procedure involves open surgery or if manipulation is not performed. It is important to follow the specific guidelines provided by the payer and to use appropriate modifiers if necessary.

8. Historical information

CPT code 23605 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Similar codes to CPT 23605

There are several similar codes to CPT code 23605 that describe different procedures for the treatment of shoulder fractures and dislocations. These include:

• CPT 23500: Closed treatment of clavicular fracture; without manipulation
• CPT 23515: Closed treatment of scapular fracture; without manipulation
• CPT 23570: Closed treatment of glenohumeral dislocation, with manipulation; requiring anesthesia
• CPT 23600: Closed treatment of proximal humeral (surgical or anatomical neck) fracture without manipulation
• CPT 23615: Closed treatment of proximal humeral (surgical or anatomical neck) fracture with manipulation; requiring anesthesia

9. Examples

1. A healthcare provider performs a closed treatment of a proximal humeral fracture with manipulation and skeletal traction for a patient who sustained a fall.
2. A patient presents with a proximal humeral fracture, and the healthcare provider performs a closed reduction without the need for skeletal traction.
3. A healthcare provider performs a closed treatment of a surgical neck fracture of the humerus with manipulation and confirms the reduction through an X-ray examination.
4. A patient with an anatomical neck fracture of the humerus undergoes closed treatment with manipulation and is placed in a sling for immobilization.
5. A healthcare provider performs a closed treatment of a proximal humeral fracture with manipulation and skeletal traction, followed by a period of immobilization in a brace.
6. A patient presents with a proximal humeral fracture, and the healthcare provider performs a closed reduction without the need for skeletal traction, followed by X-ray confirmation of the reduction.
7. A healthcare provider performs a closed treatment of a surgical neck fracture of the humerus with manipulation and skeletal traction, followed by a period of immobilization in a sling.
8. A patient with an anatomical neck fracture of the humerus undergoes closed treatment with manipulation and is placed in a brace for immobilization.
9. A healthcare provider performs a closed treatment of a proximal humeral fracture with manipulation and skeletal traction, followed by X-ray confirmation of the reduction.
10. A patient presents with a proximal humeral fracture, and the healthcare provider performs a closed reduction without the need for skeletal traction, followed by a period of immobilization in a sling.