How To Use CPT Code 23630

CPT code 23630 describes the open treatment of a greater humeral tuberosity fracture, including internal fixation if performed. 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 23630?

CPT 23630 is used to describe the open treatment of a greater humeral tuberosity fracture, which involves the use of internal fixation implants, such as pins or screws, if necessary. This code is used when a provider performs a surgical procedure to repair a crack in the greater tubercle, which is the rounded projection at the upper end of the humerus bone.

2. Official Description

The official description of CPT code 23630 is: ‘Open treatment of greater humeral tuberosity fracture, includes internal fixation, when performed.’

3. Procedure

During the procedure for CPT 23630, the provider begins by preparing the patient and administering anesthesia. Once the patient is appropriately prepped and anesthetized, the provider makes an incision in the skin over the fractured bone. They then carefully dissect through the subcutaneous tissue, taking care to protect the nerves and vessels in the area.

Next, the provider retracts the muscles to gain adequate exposure of the fracture. They then realign the fractured fragments, adjusting the bone to reduce the fracture. If necessary, the provider may use implants such as screws, nails, or wires to fix the fracture and hold the bone in place.

After the fracture has been stabilized, the provider closes the wound by suturing the skin layers together. Finally, they may place the patient in a sling or brace to immobilize the arm and shoulder for a period of four to six weeks, which aids in the healing process. In some cases, the provider may also perform an X-ray examination of the upper end of the humerus to confirm the reduction of the fracture.

4. Qualifying circumstances

CPT 23630 is performed on patients with a greater humeral tuberosity fracture, which is a crack in the greater tubercle of the humerus bone. This procedure is typically indicated when the fracture requires surgical intervention and internal fixation to ensure proper healing and alignment of the bone.

5. When to use CPT code 23630

CPT code 23630 should be used when a provider performs an open treatment of a greater humeral tuberosity fracture and includes internal fixation if necessary. This code is appropriate when the fracture requires surgical intervention and the use of implants to stabilize the bone.

6. Documentation requirements

To support a claim for CPT 23630, the provider must document the following information:

• Patient’s diagnosis of a greater humeral tuberosity fracture
• Description of the procedure performed, including the use of internal fixation if applicable
• Date of the procedure
• Start and end time of the procedure
• Details of any additional procedures performed, such as X-ray examination
• Any complications or unexpected findings during the procedure
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 23630, ensure that the procedure performed meets the criteria for an open treatment of a greater humeral tuberosity fracture with internal fixation. It is important to accurately document the procedure and any additional services provided, such as X-ray examinations, to support the claim.

There are no specific guidelines regarding reporting CPT code 23630 with other codes. However, it is important to follow any applicable bundling or unbundling rules and guidelines provided by payers.

8. Historical information

CPT code 23630 was added to the Current Procedural Terminology system on January 1, 1990. On January 1, 2008, the code description was updated to include the option of performing the procedure with or without internal or external fixation.

9. Similar codes to CPT 23630

Five similar codes to CPT 23630 include:

• CPT 23615: Open treatment of humeral shaft fracture, includes internal fixation, when performed
• CPT 23616: Open treatment of humeral shaft fracture with insertion of intramedullary implant, with or without cerclage and/or locking screws
• CPT 23620: Treatment of humeral supracondylar fracture, includes internal fixation, when performed
• CPT 23650: Open treatment of radial and ulnar shaft fractures, includes internal fixation, when performed
• CPT 23670: Open treatment of radial and ulnar shaft fractures with insertion of intramedullary implant, with or without interlocking screws and/or cerclage

9. Examples

1. A patient sustains a greater humeral tuberosity fracture due to a fall. The provider performs an open treatment of the fracture, using screws for internal fixation.
2. A professional athlete fractures their greater tubercle during a game. The provider performs an open treatment of the fracture, using pins for internal fixation.
3. An elderly patient falls and fractures their greater tubercle. The provider performs an open treatment of the fracture, using wires for internal fixation.
4. A patient involved in a car accident fractures their greater humeral tuberosity. The provider performs an open treatment of the fracture, using a combination of screws and plates for internal fixation.
5. A patient with osteoporosis sustains a greater tubercle fracture after a minor fall. The provider performs an open treatment of the fracture, using a nail for internal fixation.
6. A young athlete fractures their greater tubercle during a sports practice. The provider performs an open treatment of the fracture, using a combination of screws and wires for internal fixation.
7. A patient with a history of osteoarthritis fractures their greater humeral tuberosity. The provider performs an open treatment of the fracture, using a plate for internal fixation.
8. An elderly patient slips and falls, resulting in a greater tubercle fracture. The provider performs an open treatment of the fracture, using a combination of screws and nails for internal fixation.
9. A patient sustains a greater humeral tuberosity fracture in a workplace accident. The provider performs an open treatment of the fracture, using a combination of screws and wires for internal fixation.