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Disarticulation of the shoulder, as described by CPT® Code 23920, refers to the surgical amputation of the arm at the shoulder joint. This procedure is infrequently performed and is typically reserved for patients with severe conditions such as extensive malignant tumors or significant traumatic injuries that necessitate the removal of the arm. The procedure involves a meticulous surgical approach, beginning with a subclavicular incision along the lateral third of the clavicle. This incision allows the surgeon to access the underlying structures, including the pectoralis major muscle, which is carefully dissected to create a pathway between the pectoralis minor and subclavian muscles. The subclavian vein and artery are then exposed, ligated, and divided to ensure proper blood flow management during the procedure. The surgical steps continue with the creation of skin incisions that facilitate the detachment of various muscles from the humerus, including the deltoid, supraspinatus, and infraspinatus. The procedure also involves severing the long head of the biceps, long head of the triceps, and teres minor muscles, along with the pectoralis major. The neurovascular bundle is exposed, and critical nerves, such as the axillary nerve, are identified and transected to complete the disarticulation. After all necessary soft tissues and the shoulder capsule are divided, the arm is removed, and the remaining musculature is closed. The deltoid muscle is sutured over the underlying structures, and drains may be placed as needed to manage postoperative fluid accumulation. This comprehensive approach ensures that the procedure is performed with precision, addressing the complex anatomy of the shoulder region while preparing the patient for recovery.
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The disarticulation of the shoulder, coded as CPT® 23920, is indicated for specific medical conditions that necessitate the removal of the arm at the shoulder joint. These indications include:
The procedure for shoulder disarticulation involves several critical steps, each designed to ensure the safe and effective removal of the arm while minimizing complications. The steps include:
Post-procedure care following a shoulder disarticulation involves monitoring for complications and managing recovery. Patients may require pain management and wound care to ensure proper healing. The surgical site should be regularly assessed for signs of infection or other complications. Rehabilitation may be necessary to help the patient adjust to the loss of the arm and to promote overall recovery. Follow-up appointments will be essential to evaluate the healing process and to address any concerns that may arise during recovery.
| Short Descr | DISARTICULATION SHOULDER | Medium Descr | DISARTICULATION SHOULDER | Long Descr | Disarticulation of shoulder; | 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) | 1 - 150% payment adjustment for bilateral procedures applies. | 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 | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P3D - Major procedure, orthopedic - other | MUE | 1 | CCS Clinical Classification | 164 - Other OR therapeutic procedures on musculoskeletal system |
| 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. | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 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. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 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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| 2023-01-01 | Note | Short description changed. |
| 2010-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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