Overview of CPT Code 23405: Arthroscopy, shoulder, surgical; with rotator cuff repair
CPT Code 23405 refers to a surgical procedure performed via arthroscopy to repair a torn rotator cuff in the shoulder. This minimally invasive technique allows for better visualization and access to the shoulder joint, facilitating effective repair of the rotator cuff.
When CPT Code 23405 is Used?
This procedure is indicated in various clinical scenarios.
- Significant rotator cuff tears that cause pain and limit shoulder function.
- Chronic shoulder pain not relieved by conservative treatments.
- Acute rotator cuff injuries resulting from trauma or overuse.
- Shoulder instability associated with rotator cuff tears.
Symptoms Indicating This Procedure
Patients may report several symptoms that suggest the need for this procedure.
- Persistent shoulder pain, especially during overhead activities.
- Weakness in the shoulder or arm.
- Limited range of motion in the shoulder joint.
- Pain that worsens at night or with specific movements.
Causes and Risk Factors
Understanding the causes and risk factors can help in prevention and early intervention.
- Age-related degeneration of the rotator cuff.
- Repetitive overhead activities, common in athletes and certain occupations.
- Acute injuries from falls or accidents.
- Previous shoulder injuries or surgeries.
Diagnostic Tests Before Procedure
Several diagnostic tests may be performed to confirm the need for surgery.
- MRI of the shoulder to visualize the rotator cuff and surrounding structures.
- Ultrasound to assess the integrity of the rotator cuff.
- X-rays to rule out other shoulder conditions.
Procedure Description
The procedure involves several key steps to ensure successful repair.
- The patient is placed under general anesthesia.
- Small incisions are made around the shoulder joint.
- An arthroscope is inserted to visualize the inside of the shoulder.
- The torn rotator cuff is identified and assessed.
- Surgical instruments are used to repair the tear, often with sutures or anchors.
- The incisions are closed, and the shoulder is bandaged.
Preparation for the Procedure
Proper preparation is essential for a successful surgery.
- Avoid eating or drinking after midnight before the surgery.
- Discuss any medications with your doctor, especially blood thinners.
- Arrange for someone to drive you home post-surgery.
- Wear loose-fitting clothing on the day of the procedure.
Recovery and Aftercare
Recovery can vary, but certain guidelines are generally followed.
- Initial recovery may take 4 to 6 months for full function.
- Physical therapy is often recommended to regain strength and mobility.
- Keep the surgical area clean and dry; follow wound care instructions.
- Pain management may include prescribed medications or over-the-counter pain relievers.
Possible Complications
While complications are rare, they can occur.
- Infection at the surgical site.
- Persistent pain or stiffness in the shoulder.
- Re-tear of the rotator cuff.
- Nerve or blood vessel injury during surgery.
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Post-Procedure Follow-Up
Follow-up appointments are crucial for monitoring recovery.
- Initial follow-up within 1 to 2 weeks post-surgery.
- Regular check-ups every few weeks during the recovery period.
- Assessment of shoulder function and physical therapy progress.
Alternative Treatments
Non-surgical options may be considered before surgery.
- Physical therapy to strengthen shoulder muscles.
- Corticosteroid injections to reduce inflammation.
- Activity modification to avoid aggravating the injury.
- Pain management with medications.
Home Care Tips
Patients can take several steps to aid recovery at home.
- Follow all post-operative care instructions from your surgeon.
- Use ice packs to reduce swelling and pain.
- Engage in prescribed physical therapy exercises as directed.
- Avoid lifting heavy objects or strenuous activities until cleared.
Patient Education & Prevention
Education is key to preventing future injuries.
- Maintain shoulder strength and flexibility through regular exercise.
- Use proper techniques during sports and physical activities.
- Avoid repetitive overhead motions when possible.
- Seek early treatment for shoulder pain to prevent worsening conditions.
Billing and Coding Information
CPT Code: 23405
Category: Surgical Procedures
Common Modifiers:
- 50 - Bilateral procedure
- RT - Right side
- LT - Left side
Average Cost and Insurance Coverage
Costs can vary based on several factors.
- Average cost ranges from $10,000 to $20,000 depending on facility and location.
- Most insurance plans cover the procedure if deemed medically necessary.
- Out-of-pocket costs may vary based on deductible and co-insurance.
Related CPT Codes
Frequently Asked Questions (FAQs)
What is a rotator cuff?
The rotator cuff is a group of muscles and tendons that stabilize the shoulder joint.
How long does the surgery take?
The procedure typically takes about 1 to 2 hours.
Will I need physical therapy after surgery?
Yes, physical therapy is usually recommended to aid recovery.
What can I expect during recovery?
You can expect some pain and swelling, but this will improve over time.
