How To Use CPT Code 23900

CPT 23900 describes the surgical procedure known as interthoracoscapular amputation, also referred to as forequarter amputation. 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 23900?

CPT 23900 is a code used to describe the surgical removal of the upper extremity, scapula (shoulder blade), and clavicle (collar bone) in a procedure known as interthoracoscapular amputation or forequarter amputation. This procedure is typically performed when there is bone cancer of the shoulder or other conditions that necessitate the removal of these structures.

2. Official Description

The official description of CPT code 23900 is: ‘Interthoracoscapular amputation (forequarter).’

3. Procedure

During a CPT 23900 procedure, the healthcare provider begins by making an incision along the shoulder girdle. They then dissect through the subcutaneous tissue to create a skin flap that will cover the wound after the procedure. The provider exposes the muscles around the shoulder joint and releases them. They ligate the blood vessels and divide the nerves. The muscles anchoring the scapula to the chest wall are released, and the clavicle is disarticulated from the sternum. This allows for the removal of the entire upper extremity, collar bone, and shoulder blade. The provider then stops any bleeding at the surgical site and closes the wound by suturing the skin flap in layers over the wound.

4. Qualifying circumstances

CPT 23900 is typically performed when there is bone cancer of the shoulder or other conditions that require the complete removal of the upper extremity, scapula, and clavicle. The procedure is reserved for cases where less extensive surgical options are not feasible or would not adequately address the patient’s condition.

5. When to use CPT code 23900

CPT code 23900 should be used when a healthcare provider performs an interthoracoscapular amputation or forequarter amputation. It is important to note that this procedure is not commonly performed and is reserved for specific cases where other surgical options are not suitable.

6. Documentation requirements

To support a claim for CPT 23900, the healthcare provider must document the following information:

• Patient’s diagnosis necessitating the interthoracoscapular amputation
• Description of the procedure performed
• Date of the procedure
• Any additional details relevant to the specific case
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 23900, ensure that the procedure performed aligns with the description of interthoracoscapular amputation. It is important to follow the specific guidelines and requirements set forth by the payer to ensure accurate billing and reimbursement.

8. Historical information

CPT 23900 was added to the Current Procedural Terminology system on January 1, 1990. It has undergone changes in its status as an inpatient-only procedure, being removed from the Inpatient Only (IPO) list in 2021 but added back in 2022.

9. Similar codes to CPT 23900

There are several similar codes to CPT 23900 that describe different types of amputation procedures on the shoulder. These include:

• CPT 23901: Interthoracoscapular amputation with chest wall resection
• CPT 23920: Disarticulation at shoulder joint
• CPT 23921: Disarticulation at shoulder joint with chest wall resection

9. Examples

1. A patient with advanced bone cancer of the shoulder undergoes interthoracoscapular amputation to remove the affected structures.
2. An individual with a severe traumatic injury to the shoulder requires a forequarter amputation to address the extent of the damage.
3. A patient with a rare congenital condition necessitates the removal of the upper extremity, scapula, and clavicle through interthoracoscapular amputation.
4. Someone with a recurrent infection in the shoulder area undergoes forequarter amputation to prevent further complications.
5. A patient with a large tumor involving the shoulder requires interthoracoscapular amputation as part of their treatment plan.
6. An individual with a non-responsive shoulder joint infection undergoes forequarter amputation to eliminate the source of the infection.
7. A patient with extensive trauma to the shoulder and surrounding structures requires interthoracoscapular amputation to address the severity of the injury.
8. Someone with a rare malignant tumor in the shoulder area undergoes forequarter amputation as part of their cancer treatment.
9. A patient with a chronic degenerative condition affecting the shoulder joint necessitates interthoracoscapular amputation to alleviate their symptoms and improve their quality of life.
10. An individual with a severe vascular disease in the shoulder area undergoes forequarter amputation to prevent further complications and improve blood flow.