How To Use CPT Code 23615

CPT code 23615 describes the open treatment of a proximal humeral (surgical or anatomical neck) fracture, including internal fixation and repair of tuberosity(s) if necessary. 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 23615?

CPT 23615 is used to describe the open treatment of a proximal humeral (surgical or anatomical neck) fracture. This procedure involves the use of internal fixation, such as pins or screws, to stabilize the fracture. Additionally, if necessary, the provider may also repair the tuberosity(s), which are the rounded projections on the upper end of the humerus.

2. Official Description

The official description of CPT code 23615 is: ‘Open treatment of proximal humeral (surgical or anatomical neck) fracture, includes internal fixation, when performed, includes repair of tuberosity(s), when performed.’

3. Procedure

During the procedure for CPT 23615, the provider performs an open treatment of a surgical or anatomical neck fracture of the upper end of the humerus. This involves making an incision over the fractured bone and dissecting through the subcutaneous tissue to expose the fracture. The provider then adjusts the bone fragments to reduce the fracture and may use internal fixation implants, such as screws or pins, to stabilize the fracture. If necessary, the provider also repairs the tuberosity(s) on the upper end of the humerus. The incision is then closed, and the patient is placed in a sling or brace to aid in healing.

4. Qualifying circumstances

CPT 23615 is performed on patients with a proximal humeral (surgical or anatomical neck) fracture that requires open treatment. The procedure may include internal fixation using implants like pins or screws, as well as repair of the tuberosity(s) on the upper end of the humerus. The provider must assess the patient’s condition and determine the need for this specific treatment approach.

5. When to use CPT code 23615

CPT code 23615 should be used when the provider performs an open treatment of a proximal humeral (surgical or anatomical neck) fracture, including internal fixation and repair of tuberosity(s) if necessary. This code is appropriate when the procedure is performed on an individual patient.

6. Documentation requirements

To support a claim for CPT 23615, the provider must document the following information:

• Patient’s diagnosis of a proximal humeral (surgical or anatomical neck) fracture
• Details of the procedure performed, including the use of internal fixation and repair of tuberosity(s)
• Date of the procedure
• Start and end time of the procedure
• Any additional procedures or services performed during the same encounter
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 23615, ensure that the procedure meets the criteria for open treatment of a proximal humeral (surgical or anatomical neck) fracture, including internal fixation and repair of tuberosity(s) if necessary. It is important to use the appropriate CPT code based on the specific procedure performed. Additionally, be aware of any bundling or unbundling guidelines that may apply to this code.

8. Historical information

CPT 23615 was added to the Current Procedural Terminology system on January 1, 1990. Since its addition, there have been several changes to the code description, including updates to clarify the inclusion of internal fixation and repair of tuberosity(s) when performed.

9. Similar codes to CPT 23615

There are several similar codes to CPT 23615 that describe different procedures for the treatment of proximal humeral fractures. These include:

• CPT 23616: Open treatment of proximal humeral surgical or anatomical neck fracture, includes internal fixation, when performed, includes repair of tuberosity, when performed with proximal humeral prosthetic replacement.
• CPT 23600: Closed treatment of proximal humeral (surgical or anatomical neck) fracture; without manipulation.
• CPT 23605: Closed treatment of proximal humeral (surgical or anatomical neck) fracture; with manipulation.
• CPT 23630: Closed treatment of proximal humeral (surgical or anatomical neck) fracture; with insertion of intramedullary implant, humeral.
• CPT 23650: Open treatment of proximal humeral (surgical or anatomical neck) fracture, includes internal fixation, when performed.

9. Examples

1. A patient sustains a proximal humeral fracture and undergoes open treatment with internal fixation and repair of tuberosity(s) by the orthopedic surgeon.
2. A cyclist falls and fractures the surgical neck of the humerus. The orthopedic surgeon performs open treatment, including internal fixation and repair of tuberosity(s) to stabilize the fracture.
3. An elderly patient with osteoporosis fractures the anatomical neck of the humerus. The orthopedic surgeon performs open treatment, including internal fixation and repair of tuberosity(s) to restore stability to the fracture.
4. A young athlete sustains a complex proximal humeral fracture during a sports event. The orthopedic surgeon performs open treatment, including internal fixation and repair of tuberosity(s) to ensure proper healing and functional recovery.
5. A patient involved in a motor vehicle accident fractures the proximal humerus. The orthopedic surgeon performs open treatment, including internal fixation and repair of tuberosity(s) to realign the fractured bone and promote healing.
6. An elderly patient with a history of falls fractures the surgical neck of the humerus. The orthopedic surgeon performs open treatment, including internal fixation and repair of tuberosity(s) to stabilize the fracture and prevent further complications.
7. A patient with a history of osteoporosis sustains a proximal humeral fracture. The orthopedic surgeon performs open treatment, including internal fixation and repair of tuberosity(s) to restore stability and function to the fractured bone.