Clavicle ORIF

CPT 23515
Approach Open
Add-on / Variant CPTs
  • 23500 — Closed treatment clavicle fracture, without manipulation
Preoperative Diagnosis:

Right [left] midshaft [/ lateral] clavicle fracture, [displaced / comminuted / shortening >2 cm / Z-type deformity]

Postoperative Diagnosis:

Same

Procedure Performed:

Right [left] clavicle fracture open reduction and internal fixation, [superior / anterior-inferior] locking plate

Attending Surgeon:

[Attending name], MD/DO

First Assistant:

[Resident/PA name]

Anesthesia:

General endotracheal with interscalene nerve block [/ MAC with regional]

Indications:

The patient is a [age]-year-old [male/female] who sustained a right [left] midshaft clavicle fracture after [mechanism: fall / direct blow / MVA]. Radiographs demonstrate [displacement >100% / shortening >2 cm / Z-type deformity / open fracture / neurovascular compromise / floating shoulder], meeting criteria for surgical fixation. The risks, benefits, and alternatives were discussed and informed consent was obtained.

Findings:

The clavicle fracture was at the [middle / middle-lateral] third with [comminution / a butterfly fragment / oblique fracture pattern]. Fracture shortening was [X] mm. Anatomic reduction was achieved. The plate was centered over the fracture site. Final fixation achieved [X] cortices proximal and [X] cortices distal to the fracture.

Description of Procedure:

The patient was positioned supine [/ in beach chair] with the operative shoulder elevated on a bump. The clavicle was prepped and draped. An incision was made directly over the [middle third of the] clavicle, following Langer's skin lines [or transversely] to minimize scar conspicuity.

The platysma was divided. The fracture was exposed with subperiosteal dissection, protecting the [supraclavicular nerves] superiorly and the subclavius and neurovascular structures inferiorly. The fracture was reduced with reduction clamps, restoring length and alignment. [Comminuted fragments were anatomically reduced and provisionally fixed with K-wires.]

A [precontoured superior / anterior-inferior] clavicle locking plate was applied to the [superior / anteroinferior] surface. [X] locking screws were placed proximal and [X] distal to the fracture (minimum [3] cortices of fixation on each side). Screw lengths were confirmed fluoroscopically to avoid subclavian vessel injury inferiorly. Final fluoroscopy confirmed anatomic alignment and appropriate plate/screw position.

The wound was irrigated. The periosteum and platysma were closed with [2-0 Vicryl]. Skin was closed with [3-0 Monocryl]. A sling was applied.

Complications:

None

Specimens:

None

Estimated Blood Loss:

Minimal

Drains:

None

Disposition:

The patient was placed in a sling. Pendulum exercises were permitted immediately. Overhead activity was restricted for [4–6 weeks]. Follow-up with radiographs in [2 weeks].

Epic SmartPhrase Version 
PREOPERATIVE DIAGNOSIS: Right/Left midshaft clavicle fracture, displaced
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: Right/Left clavicle ORIF, *** plate
ATTENDING: ***, MD/DO
ASSISTANT: ***
ANESTHESIA: General + interscalene block

INDICATIONS: .PTAGE-year-old .PTSEX with *** clavicle fracture, *** mm shortening. Criteria for fixation met. Consent obtained.

FINDINGS: *** third fracture, ***. Shortening *** mm. Anatomic reduction achieved. Plate: *** cortices proximal, *** distal.

PROCEDURE:
Supine/beach chair, shoulder bump. Incision over middle clavicle. Platysma divided. Subperiosteal dissection, supraclavicular nerves protected. Fracture reduced, clamps. [Comminuted fragments reduced, K-wires.] *** plate applied ***. *** screws each side, *** cortices. Screw lengths confirmed fluoro — no subclavian impingement. Final fluoro: anatomic alignment. Irrigated. Periosteum/platysma 2-0 Vicryl. Skin closed. Sling.

EBL: Minimal
COMPLICATIONS: None
DISPOSITION: Sling. Pendulums immediately. Follow-up 2 weeks.

Signed: .ME, .MYDEGREE
.TODAY
Variants

Lateral Clavicle Fracture: Hook Plate

For a lateral clavicle fracture with CC ligament disruption (Neer Type II), a [3.5-mm] hook plate was used. The hook was placed under the posterior acromion and the plate along the superior clavicle, reducing the lateral fragment in relation to the medial clavicle. The hook plate requires planned removal at [3–4 months] once fracture union is confirmed, as leaving it in place causes subacromial impingement. Document the planned removal at the time of initial fixation.

Charting Tips
  • Document screw depth confirmation to avoid subclavian vessel injury. Clavicle screws must not penetrate the inferior cortex where the subclavian vein lies in immediate proximity. Document fluoroscopic or direct visualization confirming no inferior cortex penetration.
  • Document the number of cortices of fixation on each side of the fracture. Plate fixation with fewer than 3 bicortical screws on either side is associated with hardware failure and non-union. Document the cortex count explicitly.
  • Document fracture shortening measurement. Non-operative treatment of clavicle fractures with shortening >2 cm is associated with worse functional outcomes and higher non-union rates. The pre-operative shortening measurement justifies the operative indication.
Billing Tips
  • Bill 23515 for clavicle ORIF (9.45 wRVU, 90-day global). Use for displaced midshaft clavicle fractures treated with plate and screws. Technique (plate size, screw count) does not change the code.
  • Distal clavicle fracture with acromioclavicular joint involvement may use a different code. Confirm the anatomic location (midshaft vs. distal) to select the correct code. AC joint repair uses 23550/23552.
  • 90-day global period: sling management, shoulder exercises, wound checks, and serial X-rays are bundled. Hardware removal for symptomatic plate at a later date is separately billable (23480 or unlisted).
  • Document fracture classification (Robinson, AO), displacement amount, neurovascular exam, and all implants placed (plate name, length, screw sizes and positions), as these are required for implant registry and follow-up planning.
  • Nonoperative management of clavicle fractures is billed with fracture care codes (23500-23505). Do not use surgical codes for closed treatment. Once ORIF is performed, the global period begins with the operative date.