What was done here was a Closed Manipulative Reduction of a Closed Fracture of the Proximal Humerus with Percutaneous Pin Fixation, with X-ray imaging of the fracture reduction and the placement of the pin fixation. This could not be done without some form of general anesthesia, provided by an Anesthesiologist &/or CRNA. Their charges are separate from the Surgeon's charges for their professional work, plus a facility fee for the OR and Anesthesia Equipment. The Operative Procedure includes all the work done by the Surgeon including the use of the X-ray to monitor the reduction and guide the placement of the pin fixation. These are an "integral" part of the procedure. Since there was no incision to expose the fracture itself, the Stab Wounds made for the pin placement do not make it an "open" procedure.
There is no specific CPT Code for this particular procedure. The closest is 23605 since it covers closed manipulative reduction, but strangely includes the possibility of applying Skeletal Traction (which requires placement of a metal pin through the humerus at some point other than the fracture site) or Skin Traction (doesn't require a pin anywhere the bone). For practical purposes, Skeletal Traction for a proximal humeral fracture is not used any more, and I can't figure out why it is still in the Descriptor. You might be able to use 23605 plus Modifier 22: Increased Procedural Service (for the placement of the pin fixation under X-ray guidance). About the only other possibility would be 23929: Unlisted procedure, shoulder. You would need to send the Operative Report (at least) for supportive documentation.
Respectfully submitted, Alan Pechacek, M.D.
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