2025 CPT code 23410
Effective Date: N/A Surgery - Surgical Procedures on the Musculoskeletal System Feed
Open repair of an acute tear of the rotator cuff of the shoulder.
Modifiers may be applicable to 23410 to indicate specific circumstances, such as the anatomical location (RT/LT), unusual service or complexity (22), multiple procedures (51), or when only part of the service is performed (52, 54, 55, 56). Specific circumstances and documentation should be clearly explained for appropriate application.
Medical necessity for 23410 is established by documenting functional limitations, persistent pain despite conservative treatment, and imaging evidence of an acute rotator cuff tear impacting the patient's quality of life.
The physician is responsible for the entire surgical procedure, including diagnosis, preoperative planning, the surgical repair itself, and postoperative care within the global period.
In simple words: This procedure fixes a recent tear in the rotator cuff, a group of muscles in your shoulder. The surgeon makes an incision, finds the tear, and stitches it back to the bone, sometimes using anchors for a stronger hold.
Open surgical repair of an acute complete or partial tear of the rotator cuff tendons. This includes the deltoid muscle incision, subacromial bursectomy or subdeltoid bursectomy, identification of the rotator cuff tear, repair of the torn tendon to the bone, and closure of the wound. The procedure also involves removing frayed tendon segments, suturing the tear, and potentially using bone anchors to fix the tendon to the bone.
Example 1: A 25-year-old baseball player experiences sudden shoulder pain after a forceful throw, diagnosed with an acute rotator cuff tear after an MRI. He undergoes open repair using code 23410., A 40-year-old construction worker falls and injures their shoulder, resulting in an acute rotator cuff tear confirmed by physical exam and imaging. Surgical repair is performed using code 23410., A 60-year-old patient suffers an acute rotator cuff tear during a car accident. Open surgical repair is performed to address the tear, billed under code 23410.
Detailed operative report documenting the location and extent of the rotator cuff tear (complete or partial), the method of repair, any associated procedures like bursectomy or acromioplasty, and any complications encountered. Preoperative imaging studies (MRI, X-ray) confirming the diagnosis. Medical necessity documentation explaining why surgical intervention was required.
- RVU: 24.22 (as of 2021)
- Global Days: Global days are typically associated with surgical procedures and represent the period after the surgery during which the surgeon is responsible for postoperative care. For 23410, this period can be 0, 10, or 90 days based on specific payer guidelines. These guidelines determine whether additional evaluation and management services during this time require specific modifiers for billing.
- Specialties:Orthopedic Surgery, Sports Medicine
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center, Outpatient Hospital