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A sequestrectomy is a surgical procedure aimed at removing a sequestrum, which is a segment of necrotic (dead) bone that has detached from the surrounding healthy bone tissue. This procedure is particularly indicated in cases of osteomyelitis, an infection of the bone, or a bone abscess, which is a localized collection of pus within the bone. The specific focus of CPT® Code 23174 pertains to the humeral head to surgical neck region of the humerus, which is the upper arm bone. During the procedure, a surgical incision is made to access the affected area, allowing the surgeon to carefully elevate the periosteum, the fibrous tissue covering the bone, if it is healthy. The necrotic bone is then excised, and if the periosteum is viable, it is repositioned over the defect left by the removed sequestrum. In cases where the periosteum is not viable, the surgeon may find that new bone, known as involucrum, has formed around the sequestrum. In such instances, the necrotic bone is removed while preserving the involucrum, which will aid in the healing process and contribute to the formation of new bone in the defect. After the procedure, the incisions in the soft tissue and skin are closed, and a dressing is applied to protect the surgical site during the recovery phase.
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The sequestrectomy procedure, specifically CPT® Code 23174, is indicated for the following conditions:
The sequestrectomy procedure involves several critical steps to ensure the effective removal of the necrotic bone.
After the sequestrectomy, patients can expect a recovery period that may involve monitoring for signs of infection and ensuring proper healing of the surgical site. The application of a dressing helps protect the incision, and follow-up appointments may be scheduled to assess the healing process. Pain management and rehabilitation may also be part of the post-procedure care, depending on the extent of the surgery and the patient's overall health status.
| Short Descr | REMOVE HUMERUS LESION | Medium Descr | SEQUESTRECTOMY HUMERAL HEAD SURGERY NECK | Long Descr | Sequestrectomy (eg, for osteomyelitis or bone abscess), humeral head to surgical neck | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5B - Ambulatory procedures - musculoskeletal | MUE | 1 | CCS Clinical Classification | 161 - Other OR therapeutic procedures on bone |
This is a primary code that can be used with these additional add-on codes.
| 20700 | Add-on Code MPFS Status: Active Code APC N ASC N1 Manual preparation and insertion of drug-delivery device(s), deep (eg, subfascial) (List separately in addition to code for primary procedure) |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) |
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| Pre-1990 | Added | Code added. |
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