# Reverse total shoulder arthroplasty treatment for complex fracture of proximal humeru



## CCANTER (Apr 2, 2019)

I am second guessing myself for the CPT code for a reverse total shoulder arthroplasty treatment for complex fracture of right proximal humerus.

I was going to use CPT code 23472.  However now I am wondering should I be using CPT code 23616?

thanks


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## meghanhannus (Apr 4, 2019)

*Reverse total shoulder arthroplasty treatment for complex fracture of proximal humer*



CCANTER said:


> I am second guessing myself for the CPT code for a reverse total shoulder arthroplasty treatment for complex fracture of right proximal humerus.
> 
> I was going to use CPT code 23472.  However now I am wondering should I be using CPT code 23616?
> 
> thanks



Hello CCANTER,

I would think the correct CPT code would stem from whether or not your provider was performing an arthroplasty w/gleniod and proximal humeral replacement (CPT 23472) or ORIF w/ proximal humeral prosthetic replacement (CPT 23616). If you would like to post the operative report for a second look, I don't mind reviewing for you.

Hope this helps~

M.Hannus, CPC, CPMA, CRC


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## jfolz (Apr 4, 2019)

*A reverse is a total*

It sounds like from reading the description of 23616 that that code only involves repairing or replacing one component, the humeral component.  If the patient is truly receiving a Reverse total, that would include replacing the glenoid component as well, regardless of the fracture being the reason for the replacement.  Without seeing the Op Note, if the patient had normal unaltered shoulder anatomy pre-fracture, if a glenoid and humeral component are being implanted, regardless of it being an anatomical replacement or a reverse replacement, it would still be a total and I would use 23472.


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## CCANTER (Apr 5, 2019)

I really appreciate all your help here is the op note.
PREOPERATIVE DIAGNOSIS: Arthritis and complex fracture of the proximal humerus.
POSTOPERATIVE DIAGNOSIS: Arthritis and complex fracture of the proximal humerus.
PROCEDURES:
1. Reverse total shoulder arthroplasty of the right shoulder.
2. Biceps tenodesis, open.
PROCEDURE: The patient was brought to the OR and placed in the supine position. General
endotracheal intubation was achieved without complication. The patient was placed in the
beach chair position and prepped and draped in the normal sterile fashion.
Anterior approach was utilized. Skin flaps elevated, and hemostasis achieved with a Bovie.
Deltopectoral interval utilized. Retractor placed to visualize, hematoma evacuated. The rotator
cuff taken down to expose the head, which was arthritic and broken badly. The biceps was
tenodesed through a suture to bone in the proximal humerus right at the top of the fracture of
this.
The head was then removed piecemeal because of the fracture. We removed the fracture
fragments. The anterior and posterior glenoid retractors were inserted the biceps stump and
labrum removed. We then secured the baseplate with a centralized guidepin, reaming the
central hole and then inserting the baseplate and securing it with 2 locking screws, 2 non locking
screws, giving us rigid fixation of that baseplate. A 26-mm glenosphere was then attached at
the baseplate with excellent security.
We then turned our attention to the humerus, getting chatter with a 10 reamer. We inserted a 10
fracture stem, guessing the height to the best of my ability because of loss of any reference from
removal of the proximal fracture. We then trialed it and made sure that the height was
reasonable with a +3 platform. We secured the fracture stem with the lag screw distally using
the outrigger guide and the cannulas. We then removed the trial, inserted the tray +3 with a
mortise taper, reducing it back, getting us good security and length and tension.
The deltopectoral interval was then closed with 0 Monocryl. Subcutaneous layer closed.
Superficial layer closed with staples.
stable condition. 
Humeral component a size 10 stem with a distal interlocking screw for security. The tray is a
3-mm with a 26-mm glenosphere and a standard baseplate with 4 screws securing that baseplat


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## meghanhannus (Apr 8, 2019)

Hello CCANTER,

Thank you for posting the complete op report as it is helpful in choosing the correct code. The documentation supports an arthroplasty CPT 23472 as both glenoid and proximal humeral were replaced.


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