Clavicle ORIF
23515Right [left] midshaft [/ lateral] clavicle fracture, [displaced / comminuted / shortening >2 cm / Z-type deformity]
Same
Right [left] clavicle fracture open reduction and internal fixation, [superior / anterior-inferior] locking plate
[Attending name], MD/DO
[Resident/PA name]
General endotracheal with interscalene nerve block [/ MAC with regional]
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.
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.
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.
Subcutaneous dissection was carried down carefully, identifying and protecting the supraclavicular nerve branches crossing the anterosuperior clavicle in the subcutaneous plane. The platysma was divided. The fracture was exposed with subperiosteal dissection, protecting 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 [6] cortices / [3] bicortical screws 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.
None
None
Minimal
None
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. Subcutaneous dissection; supraclavicular nerve branches identified and protected. Platysma divided. Subperiosteal dissection, subclavius protected inferiorly. 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
.TODAYVariants
Lateral Clavicle Fracture: Hook Plate
For a displaced lateral clavicle fracture with CC ligament disruption (Neer Type IIB — fracture between conoid and trapezoid with conoid torn), a hook plate was used. The hook was placed subacromially, posterior to the AC joint, positioned anteriorly beneath the acromion to minimize subacromial erosion. The plate was applied along the superior clavicle, reducing the lateral fragment. The hook plate requires planned removal once union is confirmed, typically [3–6 months] — removal timing should follow radiographic evidence of healing, not a fixed interval. Document the planned removal in the operative note. CPT 23515, 90-day global.
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.
- CPT 23515 covers open treatment of clavicle fractures at any anatomic location — medial, midshaft, or distal/lateral. There is no separate CPT code for distal clavicle fracture ORIF; a hook plate for a distal clavicle fracture still bills as 23515. CPT 23550/23552 are for AC joint dislocation without fracture — do not use them for clavicle fractures.
- 90-day global period: sling management, shoulder exercises, wound checks, and serial X-rays are bundled. Hardware removal for symptomatic plate is separately billable at a later date: CPT 20680 (removal of deep implant, 5.81 wRVU, 90-day global). CPT 23480 is a clavicle osteotomy for malunion correction — not hardware removal.
- 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.
General coding reference. Verify with your institution’s billing department before submitting claims.