2025 CPT code 23101
(Active) Effective Date: N/A Revision Date: N/A Surgery - Shoulder Procedures Musculoskeletal System Feed
Arthrotomy of the acromioclavicular or sternoclavicular joint, including biopsy and/or excision of torn cartilage.
Modifiers may be applicable depending on the circumstances of the procedure. For instance, modifier 51 may apply if multiple procedures are performed during the same encounter, and appropriate laterality modifiers (RT or LT) should be applied to indicate the side of the body where the procedure was performed.
Medical necessity must be clearly established in the patient's medical record to justify the procedure.Documentation should demonstrate the presence of significant symptoms such as pain and loss of function directly attributable to the AC or SC joint pathology, unresponsive to conservative management. The arthrotomy and excision of torn cartilage should be deemed the most appropriate course of action for improving the patient's clinical condition.
The orthopedic surgeon or qualified healthcare professional is responsible for performing the arthrotomy, obtaining the biopsy, and excising any torn cartilage. Post-operative care is also within the clinical responsibility of the physician.
In simple words: This code covers surgery on the AC or SC joints of the shoulder. The doctor will make a small cut to examine the joint, take a tissue sample for testing, and/or remove damaged cartilage to reduce pain and improve movement.
This CPT code describes an arthrotomy (surgical incision into a joint) of either the acromioclavicular (AC) joint or the sternoclavicular (SC) joint.The procedure includes the surgical exploration of the joint, a biopsy (tissue sample removal for diagnostic analysis), and/or the excision (surgical removal) of any torn cartilage found within the joint.The procedure may involve removal of a tissue sample for laboratory analysis and/or the excision of torn cartilage to alleviate pain and improve mobility.
Example 1: A patient presents with chronic pain and limited range of motion in their right AC joint following a fall.An arthrotomy is performed, a biopsy is taken, and torn cartilage is excised., A patient experiences persistent pain in their left SC joint.An arthrotomy with biopsy is performed to rule out the presence of a malignancy. No torn cartilage is found., During a surgical repair of a clavicle fracture,an incidental finding of a torn cartilage in the AC joint is discovered. The surgeon performs an arthrotomy, biopsy, and excision of the torn cartilage.
* Preoperative diagnosis and clinical indications for the procedure.* Detailed operative report specifying the joint involved (AC or SC), whether a biopsy was performed, and if torn cartilage was excised.Measurement of excised tissue.* Pathological report of the biopsy if performed.* Postoperative management plan.* Any complications encountered during or after the surgery.* Appropriate imaging (X-ray, MRI, CT scan) to support the diagnosis.
** This code is primarily used for procedures performed under general or regional anesthesia.The biopsy is considered an integral part of the procedure and is not separately reportable.If substantial additional procedures are performed (beyond the description of the code), additional codes may be necessary to reflect the complete clinical service provided.
- Revenue Code: Refer to your specific payer's revenue code guidelines for appropriate revenue code selection.
- RVU: RVUs vary by geographic location and payer. Consult your local Medicare Physician Fee Schedule or other relevant payer's fee schedule for the most up-to-date RVU information.
- Global Days: The global period for this procedure is dependent on payer and local guidelines. This should be clarified with your payer.
- Payment Status: Active
- Modifier TC rule: Not applicable for this procedure.
- Fee Schedule: Fee schedules vary significantly over time and by location and payer.Refer to historical fee schedules from relevant payers for historical information.
- Specialties:Orthopedic Surgery
- Place of Service:Ambulatory Surgical Center, Hospital Inpatient, Hospital Outpatient