Summary & Overview
CPT 23585: Open Repair of Scapular (Shoulder Blade) Fracture
CPT code 23585 represents an open surgical repair of a scapular (shoulder blade) fracture, often including internal fixation with plates or screws. This code is used when a surgeon performs an open approach to reduce and stabilize the scapula after traumatic injury. Nationally, CPT 23585 is relevant to trauma and orthopedic surgical workflows, perioperative resource planning, and hospital and ambulatory surgery center billing for shoulder girdle fractures.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, common settings where the service is delivered, and the payer landscape typically involved in reimbursement and coverage decisions. The publication outlines benchmarks and utilization patterns where available, notes policy and coding considerations affecting claims for operative scapular fracture repair, and highlights related coding and billing topics clinicians and administrators commonly review when preparing operative reports and submitting claims.
This summary is intended for a national audience of clinicians, coding professionals, and administrators seeking a clear overview of CPT 23585, its clinical role, and the payer environment surrounding operative scapular fracture management.
Billing Code Overview
CPT code 23585 describes an open repair of a scapular (shoulder blade) fracture. The procedure involves a surgical incision to access the scapula and may include internal fixation using screws or plates to stabilize the bone until healing occurs.
Service Type: Orthopedic open fracture repair
Typical Site of Service: Inpatient or outpatient hospital operating room; ambulatory surgical center
Clinical & Coding Specifications
Clinical Context
A 45-year-old male construction worker presents after a fall from a ladder onto his right shoulder with severe pain, swelling, and limited range of motion. Plain radiographs and CT confirm a displaced fracture of the scapula involving the lateral border and glenoid neck with loss of shoulder stability. The orthopaedic trauma surgeon schedules an open reduction and internal fixation of the scapular fracture. Preoperative workflow includes history and physical, informed consent, review of imaging (X-ray and CT), anesthesia evaluation (typically general anesthesia), and perioperative antibiotics. In the operating room, a posterior or lateral approach is used to expose the scapula; fragments are reduced and stabilized with plates and screws per fracture pattern. Postoperative workflow includes immediate neurovascular checks, pain control, immobilization in a sling or shoulder immobilizer, wound care, and a tailored rehabilitation plan with progressive range-of-motion and strengthening under the direction of physical therapy. Follow-up radiographs are obtained to assess hardware position and fracture healing. Typical site of service is an inpatient or outpatient hospital operating room or ambulatory surgery center depending on comorbidities, fracture complexity, and insurer requirements.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Procedure performed as planned (no modifier) | Rarely used as explicit code; included in modifier lists but not typically appended — use payer-specific rules. |