Sequestrectomy is the surgical removal of a sequestrum, or a fragment of bone that has separated from healthy

bone as a result of disease or injury. In acromioplasty, a small piece of the bone’s surface (acromion) is excised. In some cases, this is done to smooth rough edges or growths on a bone near a joint.

23065 Biopsy, soft tissue of shoulder area; superficial

23066 deep

23071 Code is out of numerical sequence. See 23065-23220 23073 Code is out of numerical sequence. See 23065-23220 23075 Excision, tumor, soft tissue of shoulder area,

subcutaneous; less than 3 cm # 23071 3 cm or greater

23076 Excision, tumor, soft tissue of shoulder area, subfascial (eg, intramuscular); less than 5 cm

# 23073 5 cm or greater

23077 Radical resection of tumor (eg, sarcoma), soft tissue of shoulder area; less than 5 cm

23078 5 cm or greater

23100 Arthrotomy, glenohumeral joint, including biopsy 23101 Arthrotomy, acromioclavicular joint or sternoclavicular

joint, including biopsy and/or excision of torn cartilage 23105 Arthrotomy; glenohumeral joint, with synovectomy, with

or without biopsy

23106 sternoclavicular joint, with synovectomy, with or without biopsy

23107 Arthrotomy, glenohumeral joint, with joint exploration, with or without removal of loose or foreign body 22857—23107

Musculoskeletal System

Netter’s Atlas of Surgical Anatomy for CPT Coding

56 Moderate sedation ✚Add-on code ^Modifier 51 exempt #Resequenced code

Superior epigastric vessels

External oblique muscle (cut away) Rectus abdominis muscle

External oblique aponeurosis (cut) Internal oblique aponeurosis (cut) Transversus abdominis muscle Internal

oblique muscle (cut) Posterior layer of rectus sheath Arcuate line Inferior

epigastric vessels Anterior superior iliac spine

Superficial circumflex iliac, Superficial epigastric, Superficial

external pudendal arteries (cut) Inguinal falx (conjoint tendon)

Reflected inguinal ligament

Pubic tubercle

Cremaster muscle and fascia External spermatic fascia (cut)

Anterior layer of rectus sheath (cut) Linea alba Anterior layer of rectus sheath

Transversus abdominis muscle (cut)

Transversalis fascia (opened on left) Extraperitoneal fascia (areolar tissue)

Medial umbilical ligament (occluded part of umbilical artery)

Inferior epigastric artery and vein (cut) Site of deep inguinal ring (origin of internal spermatic fascia) Cremasteric and pubic branches of inferior epigastric artery Femoral sheath (contains femoral artery and vein)

Fat in retropubic space (of Retzius)

Pectineal fascia

Internal spermatic fascia Deep (Buck’s)

fascia of penis

Superficial fascia of penis and scrotum (cut)

Cremaster muscle and fascia (cut) External spermatic fascia (cut) 4

9 10

Inguinal ligament (Poupart’s)

Pectineal ligament (Cooper’s ) Lacunar ligament (Gimbernat’s) Pectineal ligament

(Cooper’s ) Lacunar ligament (Gimbernat’s) Inguinal ligament (Poupart’s)

FIGURE 2-20. Anterior Abdominal Wall

The anterior abdominal wall forms a flexible barrier that protects internal organs and contains muscles that assist with upper body movement. Several types of fascia support the abdomen, including Camper’s fascia, fatty and superficial; deep fibrous Scarpa’s fascia; linea alba, a fibrous layer along the abdominal midline; transversalis fascia, a barrier between the transverse abdominal muscle and extraperitoneal fascia; and linea semilunaris, a narrow fascia along the rectus abdominus muscle.

Netter’s Atlas of Surgical Anatomy for CPT Coding

Musculoskeletal System

Anterior view

Acromion Coracoacromial ligament Supraspinatus tendon (cut) Coracohumeral ligament

Greater tubercle and Lesser tubercle of humerus Transverse humeral ligament Intertubercular tendon sheath (communicates with synovial cavity)

Acromioclavicular joint capsule

(incorporating acromioclavicular ligament)

Subscapularis tendon (cut) Biceps brachii tendon (long head)

Clavicle Trapezoid

ligament Coraco- clavicular ligament Conoid

ligament

Superior transverse scapular ligament and suprascapular notch Coracoid process Communication of subtendinous bursa of subscapularis Broken line indicates position of subtendinous bursa of subscapularis Capsular

ligaments Anterior

view

Deltoid muscle (reflected)

Supraspinatus muscle Subdeltoid bursa fused with subacromial bursa Subscapularis muscle

Capsular ligament

Subdeltoid bursa Supraspinatus tendon

Capsular ligament Synovial membrane

Acromion

Acromioclavicular joint

Coracoacromial ligament Acromion

Supraspinatus tendon (fused to capsule) Subdeltoid bursa Infraspinatus tendon (fused to capsule) Glenoid cavity (cartilage) Teres minor tendon (fused to capsule)

Synovial membrane (cut edge) Opening of subtendinous bursa of subscapularis

Joint opened: Lateral view

Coracoid process Coracohumeral ligament

Coronal section through joint Biceps brachii tendon

(long head)

Superior glenohumeral ligament

Subscapularis tendon (fused to capsule) Middle glenohumeral ligament

Inferior glenohumeral

ligament Axillary recess

Glenoid cavity of scapula Deltoid

muscle

Glenoid labrum FIGURE 2-21. Shoulder Girdle

The shoulder girdle contains multiple joints. The major joint is the glenohumeral joint (GHJ), articulating the head of the humerus in the glenoid fossa of the scapula. The sternoclavicular (SC) joint stabilizes the clavicle by joining it to the superior sternum. The scapulothoracic (ST) joint is a small attachment between the scapula and rib. The acromioclavicular (AC) joint connects the clavicle to the acromion, an extension of the scapula. Together, the joints of the shoulder provide the body’s widest range of motion.

58 Moderate sedation ✚Add-on code ^Modifier 51 exempt #Resequenced code

Musculoskeletal System

Netter’s Atlas of Surgical Anatomy for CPT Coding

Semispinalis capitis muscle Splenius capitis muscle Spinous process of C7 vertebra Levator scapulae muscle

Not connected to upper limb

Rhomboid minor muscle Rhomboid major muscle

Acromion

Supraspinatus muscle Spine of scapula Infraspinatus muscle Teres minor muscle Teres major muscle

Latissimus dorsi muscle Long head

Lateral head Spinous process of T12 vertebra

of triceps brachii muscle Trapezius muscle

Deltoid muscle

Infraspinatus fascia

Triangle of auscultation

Anterior view Acromion Deltopectoral triangle

Deltoid muscle

Cephalic vein

Serratus anterior muscle

External oblique muscle Biceps

brachii muscle

Long head Short head

Anterior layer of rectus sheath

6th costal cartilage Sternum

Clavicle Clavicular head Sternocostal head Abdominal part

Pectoralis major muscle Trapezius muscle

Sternocleidomastoid muscle

Posterior view

Deltoid branch of thoracoacromial artery

Triceps brachii muscle (lateral head)

Latissimus dorsi muscle

Omohyoid muscle and investing layer of deep cervical fascia FIGURE 2-22. Muscles of the Shoulder

The muscles of the shoulder include very large mover muscles and small stabilizing muscles. The supraspinatus, infraspinatus, and teres minor protect the shoulder joint. The deltoid muscle, named for its triangular shape, covers the anterior, posterior, and lateral shoulder joint. The deltoid arises from the clavicle, acromion, and scapula and converges as a thick tendon into the humerus.

Netter’s Atlas of Surgical Anatomy for CPT Coding

Musculoskeletal System

23120 Claviculectomy; partial

23125 total

23130 Acromioplasty or acromionectomy, partial, with or without coracoacromial ligament release

23140 Excision or curettage of bone cyst or benign tumor of clavicle or scapula;

23145 with autograft (includes obtaining graft) 23146 with allograft

23150 Excision or curettage of bone cyst or benign tumor of proximal humerus;

23155 with autograft (includes obtaining graft) 23156 with allograft

23170 Sequestrectomy (eg, for osteomyelitis or bone abscess), clavicle

23172 Sequestrectomy (eg, for osteomyelitis or bone abscess), scapula

23174 Sequestrectomy (eg, for osteomyelitis or bone abscess), humeral head to surgical neck

23180 Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), clavicle 23182 Partial excision (craterization, saucerization, or

diaphysectomy) bone (eg, osteomyelitis), scapula 23184 Partial excision (craterization, saucerization, or

diaphysectomy) bone (eg, osteomyelitis), proximal humerus

23190 Ostectomy of scapula, partial (eg, superior medial angle) 23195 Resection, humeral head

23200 Radical resection of tumor; clavicle

23210 scapula

23220 Radical resection of tumor, proximal humerus

Introduction or Removal

Coding Atlas

Codes 23330 and 23333 are used to report removal of a foreign body resulting from trauma. Codes 23334 and 23335 are used to report the removal of previously placed hardware from the shoulder without a concurrent revision, also known as arthroplasty.

23330 Removal of foreign body, shoulder; subcutaneous 23333 deep (subfascial or intramuscular)

23334 Removal of prosthesis, includes debridement and synovectomy when performed; humeral or glenoid component

23335 humeral and glenoid components (eg, total shoulder)

23350 Injection procedure for shoulder arthrography or enhanced CT/MRI shoulder arthrography

Repair, Revision, and/or Reconstruction

Coding Atlas

In hemiarthroplasty of the shoulder, the head of the humerus bone is replaced. In total arthroplasty, both the head of the humerus (ball) and the glenoid (socket) are replaced. In the revision of a total arthroplasty, removal of existing hardware is inherent in the procedure and not reported separately.

23395 Muscle transfer, any type, shoulder or upper arm; single

23397 multiple

23400 Scapulopexy (eg, Sprengels deformity or for paralysis) 23405 Tenotomy, shoulder area; single tendon

23406 multiple tendons through same incision

23410 Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; acute

23412 chronic

23415 Coracoacromial ligament release, with or without acromioplasty

23420 Reconstruction of complete shoulder (rotator) cuff avulsion, chronic (includes acromioplasty) 23430 Tenodesis of long tendon of biceps

23440 Resection or transplantation of long tendon of biceps 23450 Capsulorrhaphy, anterior; Putti-Platt procedure or

Magnuson type operation

23455 with labral repair (eg, Bankart procedure) 23460 Capsulorrhaphy, anterior, any type; with bone block 23462 with coracoid process transfer

23465 Capsulorrhaphy, glenohumeral joint, posterior, with or without bone block

23466 Capsulorrhaphy, glenohumeral joint, any type multi- directional instability

23470 Arthroplasty, glenohumeral joint; hemiarthroplasty 23472 total shoulder (glenoid and proximal humeral

replacement (eg, total shoulder))

23473 Revision of total shoulder arthroplasty, including allograft when performed; humeral or glenoid component 23474 humeral and glenoid component

23480 Osteotomy, clavicle, with or without internal fixation;

23485 with bone graft for nonunion or malunion (includes obtaining graft and/or necessary fixation)

23120—23485

Musculoskeletal System

Netter’s Atlas of Surgical Anatomy for CPT Coding

60 Moderate sedation ✚Add-on code ^Modifier 51 exempt #Resequenced code

23490 Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; clavicle 23491 proximal humerus

Fracture and/or Dislocation

Coding Atlas

Bones can be characterized as appendicular or axial.

Appendicular skeletal bones form the upper and lower extremities and provide locomotion and manipulation of objects. The axial skeleton contains bones of the head, neck, and trunk. Codes used to report fractures and dislocations of the shoulder are classified by the type of reduction and stabilization required. The type of fracture does not necessarily correspond to the type of treatment;

a closed fracture may receive open treatment. Dislocations can occur in conjunction with fractures.

23500 Closed treatment of clavicular fracture; without manipulation

23505 with manipulation

23515 Open treatment of clavicular fracture, includes internal fixation, when performed

23520 Closed treatment of sternoclavicular dislocation; without manipulation

23525 with manipulation

23530 Open treatment of sternoclavicular dislocation, acute or chronic;

23532 with fascial graft (includes obtaining graft) 23540 Closed treatment of acromioclavicular dislocation;

without manipulation 23545 with manipulation

23550 Open treatment of acromioclavicular dislocation, acute or chronic;

23552 with fascial graft (includes obtaining graft) Posterior view

Superior transverse scapular ligament and suprascapular notch

Triangular space with circumflex scapular artery deep to space

Supraspinatus muscle (cut)

Infraspinatus muscle (cut) Spine of scapula

Teres major muscle

Suprascapular artery and nerve Acromion

Infraspinatus tendon (reflected) Joint capsule of shoulder

Deltoid muscle (reflected) Teres minor muscle Quadrangular space transmitting axillary nerve and posterior circumflex humeral artery Superior lateral

cutaneous nerve of arm

Deep artery of arm and Radial nerve

shown between Lateral head and Long head of

triceps brachii muscle FIGURE 2-23. Rotator Cuff

The humerus fits loosely into the shoulder joint and is held in place by a ring of muscles and tendons at its proximal head. This ring of muscles and tendons is called the rotator cuff. Tendons and muscles of the rotator cuff include the supraspinatus, intraspinatus, subscapularis, and teres minor. A rotator cuff tear can be an acute injury, a chronic condition, or an acute injury superimposed on a chronic condition.

Netter’s Atlas of Surgical Anatomy for CPT Coding

Musculoskeletal System

23490—23552

23570 Closed treatment of scapular fracture; without manipulation

23575 with manipulation, with or without skeletal traction (with or without shoulder joint involvement) 23585 Open treatment of scapular fracture (body, glenoid or

acromion) includes internal fixation, when performed

23600 Closed treatment of proximal humeral (surgical or anatomical neck) fracture; without manipulation 23605 with manipulation, with or without skeletal traction 23615 Open treatment of proximal humeral (surgical or

anatomical neck) fracture, includes internal fixation, when performed, includes repair of tuberosity(s), when performed;

Superior surface Acromial end

Shaft body

Posterior

Anterior Sternal end

Acromial facet Inferior surface

Trapezoid line Conoid tubercle

Impression for costoclavicular ligament

Sternal facet Subclavian groove

(for subclavius muscle) Posterior Anterior

Acromion Coracoid process

Acromial angle Clavicle (cut)

Supraglenoid tubercle Anatomical neck Greater tubercle Lesser tubercle Surgical neck

Deltoid tuberosity Intertubercular sulcus Crest of greater tubercle Crest of

lesser tubercle Scapula

Humerus Head of humerus

Superior border Superior angle

Suprascapular notch Neck

Medial border Subscapular fossa Infraglenoid tubercle Lateral border Inferior angle Glenoid

cavity of scapula

Suprascapular notch Superior border

Superior angle Supraspinous fossa

Spine Neck Infraspinous fossa

Medial border Lateral border

Inferior angle

Clavicle (cut)

Coracoid process Acromion

Acromial angle Notch connecting supraspinous and infraspinous fossae

Greater tubercle Head of humerus Anatomical neck Surgical neck Infraglenoid tubercle Deltoid tuberosity Radial groove Groove for

circumflex scapular vessels

Humerus Scapula

FIGURE 2-24. Bones of the Shoulder

The humeral head is more than twice the size of the glenoid socket into which it fits to form the glenohumeral joint. However, the glenoid cavity is augmented with a rim of fibrocartilage called the labrum that doubles the size of the socket. In a shoulder dislocation, the glenoid labrum is usually torn. A dislocated acromioclavicular (collar bone) joint is sometimes called a “separated shoulder.”

23570—23615

Musculoskeletal System

Netter’s Atlas of Surgical Anatomy for CPT Coding

62 Moderate sedation ✚Add-on code ^Modifier 51 exempt #Resequenced code

23616 with proximal humeral prosthetic replacement 23620 Closed treatment of greater humeral tuberosity fracture;

without manipulation 23625 with manipulation

23630 Open treatment of greater humeral tuberosity fracture, includes internal fixation, when performed

23650 Closed treatment of shoulder dislocation, with manipulation; without anesthesia

23655 requiring anesthesia

23660 Open treatment of acute shoulder dislocation

23665 Closed treatment of shoulder dislocation, with fracture of greater humeral tuberosity, with manipulation

23670 Open treatment of shoulder dislocation, with fracture of greater humeral tuberosity, includes internal fixation, when performed

23675 Closed treatment of shoulder dislocation, with surgical or anatomical neck fracture, with manipulation

23680 Open treatment of shoulder dislocation, with surgical or anatomical neck fracture, includes internal fixation, when performed

Manipulation

23700 Manipulation under anesthesia, shoulder joint, including application of fixation apparatus (dislocation excluded)

Arthrodesis

Coding Atlas

In glenohumeral arthrodesis, the joint is surgically fused and immobilized. Bone grafts may be placed to fix the joint; in other instances, hardware is placed.

23800 Arthrodesis, glenohumeral joint;

23802 with autogenous graft (includes obtaining graft)

Dalam dokumen Netter's Atlas of Surgical Anatomy for CPT® Coding (Halaman 79-86)