Summary & Overview
CPT 23190: Partial Resection of Scapula for Infection or Tumor
CPT code 23190 denotes partial resection of the scapula, a surgical procedure to remove part of the shoulder blade for indications such as infection, tumor, or structural deformity. Nationally, this code captures a specialized orthopedic or oncologic procedure with implications for hospital surgical utilization, perioperative care pathways, and post‑operative rehabilitation.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for use of the code, typical sites of service, and payer coverage considerations. The publication outlines benchmark metrics where available, common billing and coding considerations related to procedural reporting, and relevant policy or coverage updates that affect authorization and payment pathways.
This summary is intended for clinicians, coding professionals, and policy analysts seeking concise guidance on the clinical purpose of the code, expected care settings, and the payer landscape relevant to CPT code 23190. Data not available in the input is noted where specific benchmark or diagnosis mapping details would otherwise appear.
Billing Code Overview
CPT code 23190 describes a surgical procedure in which the provider removes a portion of the shoulder blade (scapula). The procedure is performed to treat conditions such as infection, tumor, or deformity affecting the scapular bone.
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Service type: Surgical resection of part of the scapula (osseous excision)
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Typical site of service: Inpatient or outpatient hospital surgical setting, or ambulatory surgery center, depending on clinical complexity and perioperative needs.
Clinical & Coding Specifications
Clinical Context
A 56-year-old patient presents with chronic, progressive pain and recurrent infection of the scapular region after prior trauma and failed conservative care. Imaging (CT and MRI) demonstrates an infected sequestrum and destructive lesion of the lateral scapular body consistent with osteomyelitis and possible neoplasm. The orthopedic surgeon schedules operative resection of the diseased portion of the scapula to remove infected and nonviable bone, obtain cultures and margins, and preserve shoulder girdle function. The clinical workflow includes preoperative evaluation (history, lab studies, imaging, and anesthesia assessment), intraoperative scapular resection with possible reconstruction or soft-tissue flap coverage, specimen submission for pathology and microbiology, and postoperative inpatient monitoring with IV antibiotics and physical therapy for range of motion and shoulder stabilization. Typical site of service is an inpatient or outpatient hospital operating room depending on complexity, wound status, and need for postoperative admission.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | (Not a standard CMS modifier; reserved) | Data not available in the input. |
11 | (Not a standard CMS modifier; sometimes payer-specific) |