Basics of CPT code 23105 & 23106

Definitions:

Arthroscopy: Use of an endoscope to examine the interior of a joint (diagnostic) or to perform surgery on joint structures (therapeutic)
Arthrotomy: Surgical incision into a joint that may include exploration, drainage, or removal of a foreign body
Synovectomy: Removal of the synovial membrane lining of a joint

Diagnosis and Indications for CPT code 23105, 23106, 29820 and 29821

• Primary osteoarthritis
• Rheumatoid arthritis
• Rheumatoid myopathy with rheumatoid arthritis
• Rupture of synovium
• Shoulder arthritis
• Synovial hypertrophy

Coding guidelines for CPT code 23105 and 23106

The physician performs an arthrotomy and synovectomy of the glenohumeral joint, with or without biopsy. With the patient lying on one side and the arm suspended in traction, the physician makes an incision overlying the shoulder. The joint capsule is exposed by dissecting down through the soft tissues and freeing and reflecting the muscles. The joint capsule is incised to expose the synovium. Motorized resectors are used to remove the synovium, the inner membrane of the articular capsule that lines the joint cavity. A sample of the tissue for biopsy may also be removed. Following completion of the synovectomy, the shoulder is irrigated, a drain tube may be placed, and the incision is closed in layers with sutures, staples, or Steri-strips. CPT code 23106 is reported if the procedure is done on the sternoclavicular joint.

Open Approach
23105 Arthrotomy, glenohumeral joint, with synovectomy, with or without biopsy
23107                  sternoclavicular joint, with synovectomy, with or without biopsy

Coding guidelines for CPT code 29820 and 29821

The patient is positioned side-lying with arm suspended using a weight and a pulley system. An anesthetic is administered. Two to four small poke hole (port) incisions are made around the shoulder joint to allow access to all areas of the shoulder joint. A solution is pumped through one of these incisions and into the joint to expand the joint for better visualization and to cleanse the joint. The arthroscope is inserted percutaneously or through a small incision allowing the physician to perform a diagnostic arthroscopic exam by visualizing the shoulder joint. The synovium is removed with a motorized synovial resector inserted through a port.

The instruments are removed and a long-acting local anesthetic may be injected into the joint to help with postoperative pain. The joint is irrigated and suture, band aid, or Steri-strips close the incisions. The area is covered with a dressing and a sling or shoulder immobilizer is applied. CPT code 29820 is reported for a partial synovectomy and code 29821 for a complete synovectomy.

Arthroscopic Approach
29820 Arthroscopy, shoulder, surgical; synovectomy, partial
29821                             synovectomy, complete