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Muscle transfer is a surgical procedure aimed at stabilizing the shoulder and/or restoring its function. This technique is particularly beneficial for patients who have experienced significant muscle atrophy or injury in the shoulder region. The procedure can involve various methods, including the local transfer of an existing shoulder muscle to a new site or the free transfer of a muscle from another part of the body, such as the gracilis muscle from the thigh. During the operation, a skin incision is made over the shoulder to access the affected muscle. The surgeon identifies the injured or atrophied muscle, which is then excised. In cases where a local muscle transfer is performed, the existing bony attachments of the muscle are severed, and the muscle is reattached at the designated new site. Conversely, if a free muscle transfer is indicated, a separate incision is made over the donor muscle, which is excised along with its nerve and blood supply. This donor muscle is then trimmed as necessary and sutured to the bones of the shoulder or, in some instances, to the ribs. This meticulous process aims to stabilize the shoulder joint and facilitate the re-innervation of the muscle, ultimately restoring motion and improving the patient's functional capabilities. It is important to note that CPT® Code 23397 specifically refers to the performance of multiple muscle transfers in the shoulder or upper arm, distinguishing it from CPT® Code 23395, which pertains to a single muscle transfer.
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Muscle transfer procedures are indicated for various conditions affecting the shoulder and upper arm, particularly when there is significant muscle atrophy or injury that compromises function. The following are specific indications for performing a muscle transfer:
The muscle transfer procedure involves several critical steps to ensure successful stabilization and restoration of function in the shoulder or upper arm. The following outlines the procedural steps involved:
After the muscle transfer procedure, patients typically require a period of recovery that may involve physical therapy to regain strength and mobility in the shoulder. Post-operative care includes monitoring for any complications, such as infection or issues with the muscle graft. Patients are often advised to follow specific rehabilitation protocols to ensure optimal healing and functional recovery. The expected recovery time can vary based on the extent of the procedure and the individual patient's condition, but gradual improvement in shoulder function is anticipated as the muscle re-innervates and strengthens over time.
| Short Descr | MUSCLE TRANSFERS | Medium Descr | MUSCLE TRANSFER SHOULDER/UPPER ARM MULTIPLE | Long Descr | Muscle transfer, any type, shoulder or upper arm; multiple | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P3D - Major procedure, orthopedic - other | MUE | 1 | CCS Clinical Classification | 160 - Other therapeutic procedures on muscles and tendons |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 81 | Minimum assistant surgeon: minimum surgical assistant services are identified by adding modifier 81 to the usual procedure number. | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) |
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