Shoulder Arthroplasty (Total / Reverse)

CPT 23472
Approach Open
Add-on / Variant CPTs
  • 23470 — Arthroplasty, glenohumeral joint; hemiarthroplasty
  • 23473 — Revision total shoulder arthroplasty
Preoperative Diagnosis:

Right [left] glenohumeral osteoarthritis [/ rotator cuff arthropathy / irreparable rotator cuff tear], end-stage, not responsive to conservative management

Postoperative Diagnosis:

Same

Procedure Performed:

Right [left] [total / reverse total] shoulder arthroplasty, [implant manufacturer/model]

Attending Surgeon:

[Attending name], MD/DO

First Assistant:

[Resident/PA name]

Anesthesia:

General endotracheal with interscalene nerve block

Indications:

The patient is a [age]-year-old [male/female] with end-stage glenohumeral [osteoarthritis / rotator cuff arthropathy] presenting with refractory shoulder pain and functional limitation. Conservative management has been exhausted. [For RSA: the rotator cuff is irreparably torn / the cuff is deficient, precluding anatomic total shoulder replacement.] The risks, benefits, and alternatives were discussed and informed consent was obtained.

Findings:

The glenohumeral joint demonstrated complete articular cartilage loss with [eburnated humeral head / posterior glenoid wear]. The subscapularis was [intact / repairable]. [For RSA: the rotator cuff was [absent / irreparably torn].] [Glenoid version was [neutral / retroversion X°].] Implants: [glenoid baseplate / glenoid component size X, humeral stem size X, humeral head/liner size X].

Description of Procedure:

The patient was positioned in the beach chair position. The shoulder was prepped and draped. A [deltopectoral / superior] approach was used. The deltopectoral interval was developed, and the cephalic vein was protected and retracted [medially / laterally].

The subscapularis was released by [lesser tuberosity osteotomy / tendon takedown at the musculotendinous junction / subscapularis peel]. The anterior capsule was excised. The humeral head was delivered into the wound.

[TOTAL SHOULDER (ANATOMIC):]
The humeral head was resected at the anatomic neck with a [136°] retroverted cut using the intramedullary guide. The canal was broached to size [X]. The glenoid was prepared by drilling at the center to [X] mm. A [keeled / pegged] polyethylene glenoid component was cemented in position at neutral version. The humeral stem was [press-fit / cemented]. A trial reduction confirmed [stability / appropriate offset / no impingement].

[REVERSE TOTAL SHOULDER (RSA):]
The glenoid was reamed and the baseplate was fixed with a central peg and [4] locking screws. A [36 / 40]-mm grommet was placed. The humeral canal was broached to size [X]. A humeral tray and [polyethylene / metal-backed] liner were assembled. Trial reduction confirmed stable range of motion and appropriate tension. Final implants were impacted.

[For both: The subscapularis was repaired [through bone tunnels / with heavy suture].] The wound was irrigated. The deltopectoral interval was closed. Skin was closed with [3-0 Monocryl].

Complications:

None

Specimens:

Humeral head sent to pathology [if indicated]

Estimated Blood Loss:

[X] mL

Drains:

None / [Hemovac]

Disposition:

The patient was taken to the PACU in a shoulder immobilizer. [For TSA: pendulum exercises at 24 hours; sling for 6 weeks.] [For RSA: immediate gentle passive ROM; sling for 4–6 weeks.] Physical therapy began on postoperative day 1.

Epic SmartPhrase Version 
PREOPERATIVE DIAGNOSIS: Right/Left glenohumeral ***, end-stage
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: Right/Left *** shoulder arthroplasty, *** implant
ATTENDING: ***, MD/DO
ASSISTANT: ***
ANESTHESIA: General + interscalene block

INDICATIONS: .PTAGE-year-old .PTSEX with end-stage glenohumeral ***, failed conservative treatment. Consent obtained.

FINDINGS: Cartilage loss ***. Subscapularis ***. Cuff ***. Glenoid version ***. Implants: ***.

PROCEDURE:
Beach chair. Deltopectoral approach. Cephalic vein preserved. Subscapularis ***. Anterior capsule excised. Humeral head delivered. [TSA: Humeral cut at anatomic neck, *** retroverted. Canal broached ***. Glenoid prepared, *** cemented.] [RSA: Glenoid reamed, baseplate fixed with central peg + *** screws, *** mm grommet. Canal broached ***. Humeral tray/liner assembled.] Trial: stable ROM, appropriate tension. Final implants seated. Subscapularis repaired. Wound irrigated. Closed.

EBL: *** mL
COMPLICATIONS: None
DISPOSITION: Immobilizer. PT POD 1.

Signed: .ME, .MYDEGREE
.TODAY
Variants

Shoulder Hemiarthroplasty (Humeral Head Replacement)

Given [intact glenoid articular cartilage / acute proximal humerus fracture / avascular necrosis with preserved glenoid], a humeral hemiarthroplasty was performed without glenoid resurfacing. The humeral head was replaced with a [stemmed / stemless] prosthesis. For fracture hemiarthroplasty, the greater and lesser tuberosities were repaired around the prosthetic stem with [heavy non-absorbable] suture in a cerclage and horizontal configuration, restoring the rotator cuff footprints. Tuberosity healing is critical for functional outcome after fracture hemiarthroplasty and requires at minimum 6 weeks of immobilization.

Charting Tips
  • Document subscapularis repair technique and security for anatomic TSA. Subscapularis failure is the most common reason for early TSA instability and reoperation. Document the repair method (LTO vs. tendon repair), suture type, and that the repair held through range of motion testing.
  • For RSA, document glenoid baseplate seating and screw fixation. The baseplate must seat flush on the reamed glenoid with no rocking. Document the number and length of locking screws, and that no rocking was seen before glenoid assembly. Baseplate failure is catastrophic.
  • Document stability testing through functional arc. For TSA, test stability in 90° abduction/external rotation (anterior apprehension position). For RSA, document that no scapular notching position was identified and that the arm could be elevated to at least 120° without subluxation.
Billing Tips
  • Bill 23470 for hemiarthroplasty of the shoulder (17.44 wRVU, 90-day global). Bill 23472 for total shoulder arthroplasty (TSA, 21.58 wRVU, 90-day global). Code selection based on whether the glenoid component is placed.
  • Reverse total shoulder arthroplasty (RTSA) uses 23472, the same code as anatomic TSA. Document reverse vs. anatomic configuration, implant specifications, and indication (rotator cuff arthropathy, primary glenohumeral arthritis).
  • Revision shoulder arthroplasty uses 23473 (revision with components, 28.93 wRVU) or 23474 (without components, 23.12 wRVU). These carry substantially higher wRVU than primary arthroplasty, so ensure revision is documented and coded correctly.
  • 90-day global period: sling management, physical therapy protocol, and routine imaging follow-up are bundled. Manipulation under anesthesia for postoperative stiffness within the global period requires modifier -78.
  • Document rotator cuff status intraoperatively (intact, partial tear, or complete tear). Concomitant subscapularis management (repair, tenotomy) and biceps tenodesis are often bundled; confirm with your billing team.