Overview of CPT Code 23406: Arthroscopic rotator cuff repair

Overview of CPT Code 23406: Arthroscopic rotator cuff repair

CPT Code 23406 refers to the surgical procedure known as arthroscopic rotator cuff repair, which is performed to fix tears in the rotator cuff using minimally invasive techniques. This procedure is typically indicated for patients experiencing significant shoulder pain and dysfunction due to rotator cuff injuries.

When CPT Code 23406 is Used?

This procedure is appropriate in various clinical scenarios, including:

• Full-thickness rotator cuff tears confirmed by imaging.
• Partial rotator cuff tears causing persistent pain and weakness.
• Shoulder instability related to rotator cuff injuries.
• Failure of conservative treatment methods such as physical therapy.

Symptoms Indicating This Procedure

Patients may report the following symptoms that indicate 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

Several factors can contribute to the development of rotator cuff tears, including:

• Age-related degeneration of the rotator cuff tendons.
• Acute injuries from falls or accidents.
• Repetitive overhead activities, common in certain sports and occupations.
• Previous shoulder injuries or surgeries.

Diagnostic Tests Before Procedure

To confirm the diagnosis and assess the extent of the injury, the following tests may be performed:

• MRI or ultrasound imaging to visualize the rotator cuff.
• X-rays to rule out other shoulder conditions.
• Physical examination to assess range of motion and strength.

Procedure Description

The arthroscopic rotator cuff repair procedure typically involves the following steps:

• 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 tendon is identified and assessed.
• The tendon is reattached to the bone using sutures or anchors.
• The incisions are closed, and the shoulder is bandaged.

Preparation for the Procedure

Patients should follow these steps to prepare for the surgery:

• Consult with the surgeon about medications to avoid, such as blood thinners.
• Arrange for transportation to and from the surgical facility.
• Follow pre-operative fasting instructions as directed.
• Discuss any allergies or medical conditions with the healthcare team.

Recovery and Aftercare

Post-operative recovery typically involves the following:

• Initial rest and immobilization of the shoulder in a sling.
• Gradual physical therapy to restore range of motion and strength.
• Pain management with prescribed medications.
• Regular follow-up appointments to monitor healing.

Possible Complications

While generally safe, this procedure carries some risks, including:

• 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 care is essential for optimal recovery, typically including:

• Initial follow-up within 1-2 weeks post-surgery.
• Regular assessments every few weeks to monitor progress.
• Physical therapy sessions as recommended by the surgeon.

Alternative Treatments

Before considering surgery, patients may explore these options:

• Physical therapy to strengthen shoulder muscles.
• Corticosteroid injections to reduce inflammation.
• Activity modification to avoid aggravating the injury.
• Pain management strategies, including over-the-counter medications.

Home Care Tips

Patients can follow these tips for effective home care:

• Keep the surgical area clean and dry.
• Follow the prescribed rehabilitation exercises.
• Use ice packs to reduce swelling and pain.
• Avoid lifting heavy objects until cleared by the doctor.

Patient Education & Prevention

To prevent future injuries, patients should consider:

• Engaging in shoulder-strengthening exercises.
• Practicing proper techniques in sports and activities.
• Avoiding repetitive overhead motions when possible.
• Maintaining a healthy weight to reduce joint stress.

Billing and Coding Information

CPT Code: 23406

Category: Surgery

Common Modifiers:

• 50 - Bilateral procedure
• RT - Right side
• LT - Left side

Average Cost and Insurance Coverage

The cost of arthroscopic rotator cuff repair can vary widely:

• Average cost ranges from $10,000 to $20,000.
• Insurance typically covers the procedure if deemed medically necessary.
• Out-of-pocket costs depend on the patient's insurance plan.

Related CPT Codes

• 23400 - Shoulder Arthroscopy for Removal of Loose Bodies
• 23410 - Repair of Rotator Cuff
• 23412 - Arthroscopic repair of shoulder labrum