Mumford Procedure: Coding Guide

The Mumford procedure, also known as distal clavicle excision or distal clavicle resection, is a medical operation performed to ameliorate shoulder pain and discomfort by excising the distal (lateral) end of the clavicle.

Distal clavicle excision is performed to treat pain occurring around the AC joint of the shoulder, usually caused by shoulder impingement or arthritis. Shoulder impingement occurs when the space within the AC joint narrows, causing the acromion to rub directly against the tendons.

The surgery can be performed using an open or arthroscopic procedure, and typically requires eight to ten weeks recovery time.

Arthroscopic Distal Clavicle Resection

Mumford procedure was an open surgery. As with open surgery, arthroscopic procedures can be performed using both direct and indirect approaches. In this type of surgery, several small incisions are made in the shoulder, and a camera and the surgical instruments are inserted into the joint.

During an open Mumford procedure using a direct approach, the patient may be given a sedative, along with general anesthesia or a regional interscalene block, which numbs the nerves in the shoulder and arm for up to 24 hours after the surgery. An incision is made on top of the AC joint, and the fibrous tissue, or fascia, over the joint is cut; it may also be necessary to release the shoulder muscles from the bone. A surgical saw is used to cut off about 0.4 to 0.8 inches (1 to 2 centimeters) or less of bone off the end of the clavicle. Pieces of the bone are removed and the tissue and skin are sutured back together.

In the indirect approach, the surgeon performs the procedure from below the joint rather than above. Many of the same steps are performed in this approach, although the bursa — a small fluid-filled sac that cushions the joint — is typically removed.

Removal of the distal clavicle (partial claviculectomy) brings pain relief to many patients, particularly those with osteoarthritis.

Coding Guideline

23120 Claviculectomy; partial

29824 Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure).

 This means excision of the entire distal clavicle (approximately 1 cm), not merely shaving off osteophytes at the acromioclavicular joint. The code for the open procedure is 23120; use 29824 for an arthroscopic procedure.

 Excision of the distal clavicle involving more than a simple shaving of osteophytes at the AC joint is reported separately whether performed open or closed, according to the American Academy of Orthopaedic Surgeons (AAOS).

 Some carriers may consider an excision of less than 1 cm inclusive to the main procedure, so always check carrier policy before reporting these codes separately.

 The open procedure requires an incision of at least two inches.