Overview of CPT Code 23455: Arthroscopic rotator cuff repair

Overview of CPT Code 23455: Arthroscopic rotator cuff repair

CPT Code 23455 refers to the surgical procedure of arthroscopic rotator cuff repair, which is performed to fix tears in the rotator cuff, a group of muscles and tendons that stabilize the shoulder joint.

When CPT Code 23455 is Used?

This procedure is indicated in various clinical scenarios.

• Full-thickness rotator cuff tears confirmed by imaging.
• Partial-thickness rotator cuff tears that cause significant pain or dysfunction.
• Chronic shoulder pain not responding to conservative treatments.
• Shoulder instability due to rotator cuff injury.

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.
• Pain at night or while resting.

Causes and Risk Factors

Understanding the causes and risk factors can help in prevention and early intervention.

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

Diagnostic Tests Before Procedure

Several diagnostic tests are utilized to confirm the need for surgery.

• MRI to visualize the rotator cuff and assess the extent of the tear.
• Ultrasound for real-time imaging of shoulder structures.
• X-rays to rule out other shoulder conditions.

Procedure Description

The procedure is performed using minimally invasive techniques.

• Patient is placed under general anesthesia.
• Small incisions are made around the shoulder.
• An arthroscope is inserted to visualize the joint.
• Torn tendons are reattached to the bone using sutures or anchors.
• The incisions are closed, and the shoulder is bandaged.

Preparation for the Procedure

Proper preparation is essential for a successful outcome.

• Avoid eating or drinking after midnight before the surgery.
• Discuss medications with your doctor, especially blood thinners.
• Arrange for transportation home post-surgery.
• Wear loose-fitting clothing for the day of the procedure.

Recovery and Aftercare

Recovery involves several stages and proper aftercare.

• Initial recovery period lasts about 4 to 6 months.
• Physical therapy is often recommended to regain strength and mobility.
• Keep the surgical area clean and dry.
• Pain management may include prescribed medications.

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 damage leading to weakness or numbness.

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Post-Procedure Follow-Up

Follow-up care is crucial for monitoring recovery.

• Initial follow-up appointment 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

There are non-surgical options available for managing rotator cuff issues.

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

Home Care Tips

Patients can take several steps at home to aid recovery.

• Follow the prescribed physical therapy regimen.
• Apply ice to the shoulder to reduce swelling.
• Avoid lifting heavy objects during the initial recovery phase.
• Use a sling as directed to support the shoulder.

Patient Education & Prevention

Education on prevention can help avoid future injuries.

• Engage in shoulder-strengthening exercises.
• Warm up properly before physical activities.
• Avoid repetitive overhead motions when possible.
• Maintain a healthy weight to reduce stress on joints.

Billing and Coding Information

CPT Code: 23455

Category: Surgery

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.
• Insurance typically covers the procedure if deemed medically necessary.
• Out-of-pocket costs depend on the insurance plan and deductible.

Related CPT Codes

• 23460 - Arthroscopic shoulder debridement
• 23462 - Arthroscopic rotator cuff repair
• 23470 - Arthroscopic rotator cuff repair