Summary & Overview
CPT 23100: Open Biopsy of Glenohumeral (Shoulder) Joint
CPT code 23100 denotes an open surgical biopsy of the glenohumeral (shoulder) joint, a diagnostic procedure to obtain tissue for histopathology. Nationally, this code is used to document invasive shoulder joint sampling when less invasive techniques are inadequate or contraindicated. The code matters for surgical billing, coding specificity, and accurate claims adjudication given the operative nature and typical facility settings.
Key payers covered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for an open shoulder joint biopsy, common sites of service such as hospital operating rooms and ambulatory surgical centers, and which payers commonly cover this type of surgical diagnostic service. The publication outlines benchmarks for utilization and payment practices where available, summarizes relevant billing considerations, and highlights policy and documentation elements that affect claim processing. Data not available in the input is noted where applicable. This resource is intended to help clinicians, coders, and administrators understand the clinical and billing identity of CPT code 23100 and what to expect in national payer contexts.
Billing Code Overview
CPT code 23100 describes an open surgical procedure in which the provider makes an incision to expose the glenohumeral joint of the shoulder and obtains a biopsy. This service is a surgical tissue biopsy of the shoulder joint intended to collect tissue samples for histopathologic evaluation.
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Service type: Open surgical biopsy
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Typical site of service: Hospital operating room or ambulatory surgical center
Data not available in the input for payers, associated taxonomies, ICD-10 diagnoses, related codes, and service line.
Clinical & Coding Specifications
Clinical Context
A 58-year-old male presents with progressive right shoulder pain, limited range of motion, and a palpable shoulder mass on exam. Imaging with MRI demonstrates an irregular lesion involving the glenohumeral joint with concern for an intra-articular neoplasm or infectious synovitis. The orthopedic surgeon schedules an open shoulder biopsy under general anesthesia to obtain representative tissue from the glenohumeral joint for histopathology and microbiology.
The clinical workflow: preoperative clinic evaluation with informed consent and relevant labs and imaging; anesthesia evaluation; perioperative antibiotics as indicated; operative positioning and sterile preparation; an open incision over the shoulder to expose the glenohumeral joint; targeted biopsy of synovium/cartilage or intra-articular lesion; hemostasis and layered closure; specimen handling and labeling for pathology and culture; postoperative recovery with analgesia, wound care instructions, and pathology follow-up to guide further management.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier (baseline) | Use when no additional modifier applies and standard reporting is appropriate |
11 |