Overview of CPT Code 23465: Arthroscopic rotator cuff repair

Overview of CPT Code 23465: Arthroscopic rotator cuff repair

CPT Code 23465 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 23465 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.
• Shoulder instability due to rotator cuff injury.
• Persistent shoulder pain despite conservative treatment.

Symptoms Indicating This Procedure

Patients may report several symptoms that suggest the need for this procedure.

• Severe shoulder pain, especially at night.
• Weakness in the shoulder or arm.
• Limited range of motion in the shoulder.
• Difficulty performing overhead activities.

Causes and Risk Factors

Understanding the causes and risk factors can help in prevention.

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

Diagnostic Tests Before Procedure

Several diagnostic tests may be performed to confirm the need for surgery.

• MRI to visualize the rotator cuff and assess the extent of the tear.
• Ultrasound imaging to evaluate 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 repaired using sutures or anchors.
• Incisions are closed with sutures or adhesive.

Preparation for the Procedure

Proper preparation is essential for a successful surgery.

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

Recovery and Aftercare

Recovery involves several stages and care practices.

• Initial recovery period lasts about 4 to 6 months.
• Physical therapy is often recommended to regain strength.
• 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 appointments are crucial for monitoring recovery.

• Initial follow-up within 1 to 2 weeks post-surgery.
• Regular check-ups every 4 to 6 weeks during recovery.
• Assessment of shoulder function and pain levels.

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 over-the-counter medications.

Home Care Tips

Patients can follow these tips for better recovery.

• Apply ice packs to reduce swelling.
• Follow prescribed physical therapy exercises.
• Avoid lifting heavy objects during recovery.
• Keep follow-up appointments with your healthcare provider.

Patient Education & Prevention

Education is key to preventing future injuries.

• Engage in shoulder-strengthening exercises.
• Use proper techniques during sports and physical activities.
• Avoid repetitive overhead motions when possible.
• Maintain a healthy weight to reduce joint stress.

Billing and Coding Information

CPT Code: 23465

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

Related CPT Codes

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