Overview of CPT Code 23485: Arthroscopy, shoulder, with rotator cuff repair

Overview of CPT Code 23485: Arthroscopy, shoulder, with rotator cuff repair

CPT Code 23485 refers to a minimally invasive surgical procedure performed on the shoulder to repair a torn rotator cuff. This procedure is typically done using an arthroscope, a small camera that allows the surgeon to visualize the inside of the shoulder joint.

When CPT Code 23485 is Used?

This procedure is indicated in various clinical scenarios.

• Significant rotator cuff tears that cause pain and limit shoulder function.
• Persistent shoulder pain despite conservative treatment options.
• Tears that are causing weakness in the shoulder.
• Acute injuries resulting in rotator cuff tears.

Symptoms Indicating This Procedure

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

• Chronic 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.
• 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 may be performed to confirm the need for surgery.

• MRI of the shoulder to visualize the rotator cuff and surrounding structures.
• Ultrasound imaging 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.
• The torn edges are brought together and secured using 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 after the procedure.
• Wear loose-fitting clothing on the day of surgery.

Recovery and Aftercare

Recovery is a crucial phase following the procedure.

• Initial rest and immobilization of the shoulder for several days.
• Gradual introduction of physical therapy as advised by the surgeon.
• Pain management with prescribed medications.
• Regular follow-up appointments to monitor healing.

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 care is important for monitoring recovery.

• First follow-up appointment within 1-2 weeks post-surgery.
• Regular check-ups every few weeks to assess healing.
• Physical therapy sessions as recommended by the surgeon.

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 steps at home to aid recovery.

• Follow the surgeon's instructions for wound care.
• Use ice packs to reduce swelling and pain.
• Engage in prescribed exercises to improve mobility.
• Avoid heavy lifting 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.

Billing and Coding Information

CPT Code: 23485

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 deemed medically necessary.
• Out-of-pocket costs depend on the insurance plan and deductible.

Related CPT Codes

• 10000 - Incision and drainage of a cyst