2025 CPT code 23615

Open treatment of a proximal humeral (surgical or anatomical neck) fracture; includes internal fixation, when performed; includes repair of tuberosity(s), when performed.

Refer to the most recent CPT coding guidelines for detailed instructions on proper coding and documentation for this procedure.

Modifiers may be applicable to this code depending on the specific circumstances of the procedure. For instance, modifier 51 may be used for multiple procedures, while modifier 59 may be applied to indicate a distinct procedural service.Consult the most recent CPT manual for specific usage guidelines for modifiers.

Medical necessity for this procedure is established when a displaced fracture of the proximal humerus, particularly involving the surgical or anatomical neck, compromises the patient's functional ability or poses a risk of complications such as malunion or non-union.The decision to proceed with open reduction and internal fixation should be based on clinical assessment and imaging findings, taking into account the patient's age, bone quality, and overall health status.

The orthopedic surgeon is primarily responsible for performing this procedure, including pre-operative planning, surgical technique, post-operative care, and follow-up. Anesthesiologists, surgical assistants, and other medical professionals may assist as needed.

IMPORTANT Consider additional codes for associated procedures such as bone grafting, nerve repair, or vascular repair, if performed separately.If only a cast or splint is applied without surgical intervention, use appropriate evaluation and management (E&M) codes.

In simple words: This code describes a surgery to fix a broken bone in the upper arm near the shoulder. The surgeon opens the skin to see the break, puts the bone pieces back together, and uses screws or plates to hold them in place. If the nearby bony bumps (tuberosities) are also broken, they're fixed as well. The surgeon will close the wound and use a sling or brace to help the bone heal.

This CPT code encompasses the open surgical treatment of a fracture located in the surgical or anatomical neck of the proximal humerus.The procedure involves surgical exposure of the fracture site, reduction of the fracture fragments to restore proper alignment, and stabilization using internal fixation devices such as plates, screws, or pins.Repair of any associated tuberosity fractures (greater or lesser tuberosity) is also included if performed.The surgical approach may involve dissection through subcutaneous tissue, muscle retraction, and meticulous protection of neurovascular structures. Post-operative management, including wound closure and application of a splint or sling, is considered inherent to the procedure.

Example 1: A 65-year-old female falls and sustains a displaced three-part fracture of the surgical neck of the humerus. Open reduction and internal fixation with a plate and screws are performed, along with repair of a greater tuberosity fracture., A 30-year-old male is involved in a motor vehicle accident, sustaining a comminuted fracture of the anatomical neck of the humerus.Open reduction and internal fixation with multiple pins and wires are used to stabilize the fracture., A 78-year-old female with osteoporosis experiences a low-energy fall resulting in a displaced two-part fracture of the surgical neck. Open reduction and internal fixation with a locking plate is performed.Due to the patient's age and comorbidities, additional post-operative management may be necessary.

** Accurate coding and documentation are crucial for proper reimbursement.Always refer to the most current CPT coding guidelines and payer-specific instructions for detailed information.

  • Revenue Code: P3D (MAJOR PROCEDURE, ORTHOPEDIC - OTHER)
  • RVU: Refer to the current year's Medicare Physician Fee Schedule for RVU values.These values vary based on geographic location and other factors.
  • Global Days : The global period for this procedure is typically 90 days, including pre-operative and post-operative care.Subsequent related procedures during the global period may require modification using CPT modifier 58.
  • Payment Status: Active
  • Modifier TC rule: A Technical Component (TC) modifier may not be directly applicable to this code, as it represents the entire procedure rather than a distinct technical component.
  • Fee Schedule : Historical fee schedule data can vary greatly depending on payer, location, and date.For historical fee schedule information, please consult an appropriate database for your specific needs.
  • Specialties:Orthopedic Surgery
  • Place of Service:Inpatient Hospital, Ambulatory Surgical Center, Outpatient Hospital
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