2025 CPT code 23190

Partial ostectomy of the scapula (e.g., superior medial angle).

Adhere to current CPT coding guidelines and payer-specific policies.Accurate documentation is critical for appropriate reimbursement.

Modifiers may be applicable depending on the circumstances of the procedure.Consult the CPT manual and payer guidelines for details.

Medical necessity for a partial scapulectomy is typically established by the presence of a bone tumor, infection, or significant deformity that compromises function or threatens the patient's well-being.The intervention should be medically indicated based on diagnostic findings and supported by appropriate imaging and pathology.

The orthopedic surgeon or qualified healthcare professional is responsible for pre-operative planning, surgical execution including incision, dissection, bone resection, hemostasis, and wound closure, as well as post-operative care.

In simple words: The doctor removes a part of the shoulder blade (scapula) to treat problems like infection, a tumor, or a deformity. This involves making an incision, removing the bone, and closing the area.

This CPT code, 23190, represents the partial surgical removal of a portion of the scapula, typically targeting the superior medial angle.The procedure involves an incision over the specified area, dissection of underlying muscles (particularly the trapezius), and excision of the bone using appropriate instruments.The bone surface is smoothed using a rasp. In cases of infection, irrigation with antibiotic solutions and drain placement may be necessary. Hemostasis is ensured before closure of the incision.The size and extent of the resection are determined by the clinical indication (e.g., tumor, infection, deformity).

Example 1: A patient presents with a benign bone tumor at the superior medial angle of the scapula.The surgeon performs a partial scapulectomy to excise the tumor, ensuring clean margins., A patient suffers a comminuted fracture of the superior medial angle of the scapula with significant bone loss.The surgeon performs a partial scapulectomy to remove the non-viable bone fragments and promote healing., A patient with osteomyelitis (bone infection) affecting the superior medial angle of the scapula requires surgical debridement.The surgeon performs a partial scapulectomy to remove infected bone tissue and place a drain.

* Preoperative diagnosis and imaging (e.g., X-rays, CT scans) demonstrating the need for surgery.* Operative report detailing the extent of the resection, any complications encountered, and the type of closure.* Pathology report confirming the diagnosis (if applicable).* Postoperative care notes documenting the patient's recovery.

** Preauthorization is often recommended as reimbursement policies may vary by payer and diagnosis.

  • Revenue Code: P3D (MAJOR PROCEDURE, ORTHOPEDIC - OTHER)
  • RVU: This information requires access to current fee schedules and may vary based on location and payer.
  • Global Days : The global period for this procedure needs to be determined based on payer-specific guidelines and the complexity of the case.
  • Payment Status: Active
  • Modifier TC rule: Not applicable.
  • Fee Schedule : Historical fee schedules vary widely based on location, payer, and year.Refer to historical fee data for specific periods.
  • Specialties:Orthopedic Surgery
  • Place of Service:Inpatient Hospital, Ambulatory Surgical Center, Outpatient Hospital
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