Summary & Overview
CPT 23550: Open Fixation of Acromioclavicular Dislocation
CPT code 23550 represents the open surgical fixation of acute or chronic acromioclavicular (AC) joint dislocations using internal fixation devices such as pins or screws. This procedure is a key orthopedic intervention for restoring shoulder girdle stability after traumatic or recurrent AC separations. Nationally, the code is relevant for hospital billing, ambulatory surgery centers, and payer coverage determinations involving operative management of shoulder injuries.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the code, common sites of service, and the types of surgical care it represents. The publication summarizes benchmarking and reimbursement context where available, highlights policy or coverage considerations that commonly affect surgical shoulder procedures, and explains how 23550 fits into orthopedic service lines.
The report provides: (1) a clinical description of the procedure and its indications; (2) payer coverage landscape and common billing practices; and (3) operational considerations for coding and site-of-service determination. Data not available in the input is identified explicitly where applicable.
Billing Code Overview
CPT code 23550 describes an open treatment of an acute or chronic acromioclavicular (AC) dislocation. The procedure addresses a new or recurring abnormal separation of the acromioclavicular joint and involves internal fixation using implants such as pins or screws to restore joint alignment.
Service Type: Surgical — open orthopedic procedure
Typical Site of Service: Inpatient or outpatient hospital operating room; ambulatory surgical center, depending on clinical severity and perioperative needs.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 34-year-old male presents to the emergency department after a fall onto his shoulder during a bicycle accident. He reports immediate pain, visible deformity at the shoulder with a high-riding clavicle, and limited overhead motion. Physical exam demonstrates tenderness over the acromioclavicular joint and instability with cross-body adduction. Radiographs confirm an acute, high-grade acromioclavicular joint dislocation with displacement. The orthopedic surgeon schedules an open reduction and internal fixation using pins or screws to stabilize the acromioclavicular joint.
The clinical workflow includes preoperative evaluation (history, targeted shoulder exam, neurovascular check), imaging review (AP, axillary, and Zanca views), informed consent discussing risks of infection, hardware complications, need for possible future hardware removal, and anesthesia planning. In the operating room, the surgeon performs open reduction of the acromioclavicular joint, achieves anatomic alignment, and places internal fixation (e.g., transacromial pins or clavicular screws) per CPT code 23550. Postoperative care includes immobilization in a sling, pain control, early passive range-of-motion per protocol, and outpatient follow-up for wound checks and radiographic assessment. Hardware removal, if performed later, is coded separately.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 |