Overview of CPT Code 23490:Arthroscopy, shoulder, surgical; with rotator cuff repair

Overview of CPT Code 23490:Arthroscopy, shoulder, surgical; with rotator cuff repair

CPT Code 23490 refers to a surgical procedure performed via arthroscopy to repair a torn rotator cuff in the shoulder. This minimally invasive technique allows for the assessment and treatment of shoulder injuries, particularly those affecting the rotator cuff, which is crucial for shoulder stability and movement.

When CPT Code 23490 is Used?

This procedure is indicated in various clinical scenarios, including:

• Significant rotator cuff tears that cause pain and limit shoulder function.
• Chronic shoulder pain not relieved by conservative treatments.
• Acute injuries resulting in rotator cuff tears.
• Shoulder instability associated with rotator cuff damage.

Symptoms Indicating This Procedure

Patients may report the following 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

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, such as in athletes or manual laborers.
• 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 of the shoulder to visualize soft tissue structures.
• Ultrasound to assess rotator cuff integrity.
• X-rays to rule out bone abnormalities or arthritis.
• Physical examination to evaluate range of motion and strength.

Procedure Description

The 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.
• Damaged tissue is removed, and the torn rotator cuff is repaired using sutures.
• The incisions are closed, and the shoulder is bandaged.

Preparation for the Procedure

Patients should follow these steps to prepare for surgery:

• Avoid eating or drinking after midnight before the surgery.
• Discuss current medications with the surgeon, especially blood thinners.
• Arrange for transportation to and from the surgical facility.
• Wear loose-fitting clothing on the day of the procedure.

Recovery and Aftercare

Post-operative recovery typically includes:

• Resting the shoulder and avoiding heavy lifting for several weeks.
• Physical therapy to regain strength and mobility.
• Pain management with prescribed medications.
• Keeping the surgical site clean and dry to prevent infection.

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 appointments are essential for monitoring recovery:

• Initial follow-up within 1-2 weeks post-surgery.
• Regular check-ups every few weeks to assess healing.
• Physical therapy sessions as recommended by the surgeon.
• Long-term follow-up to monitor shoulder function.

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 with over-the-counter medications.

Home Care Tips

Patients can follow these tips for effective home care:

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

Patient Education & Prevention

To prevent future injuries, patients should consider:

• Engaging in shoulder-strengthening exercises.
• Avoiding repetitive overhead activities without breaks.
• Maintaining a healthy weight to reduce joint stress.
• Seeking prompt treatment for shoulder pain.

Billing and Coding Information

CPT Code: 23490

Category: Surgical Procedures

Common Modifiers:

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

Average Cost and Insurance Coverage

The cost of this procedure can vary widely:

• Average cost ranges from $10,000 to $20,000.
• Insurance may cover a significant portion if deemed medically necessary.
• Out-of-pocket costs depend on the patient's insurance plan.

Related CPT Codes

• 23491 - Arthroscopic rotator cuff repair
• 23470 - Arthroscopic rotator cuff repair