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The procedure described by CPT® Code 23184 involves a partial excision of bone, specifically targeting the proximal humerus to address osteomyelitis, which is an infection of the bone. This surgical intervention is also known by terms such as craterization, saucerization, or diaphysectomy. Craterization and saucerization refer to techniques that create a shallow depression in the bone surface by removing infected and necrotic bone, thereby facilitating drainage from the infected area. Diaphysectomy, on the other hand, involves the removal of the infected segment of the shaft of a long bone. The procedure begins with an incision through the skin and soft tissue over the site of infection, allowing access to the affected area. During the operation, any soft tissue sinus tracts and devitalized soft tissue are excised to ensure a clean surgical field. The surgeon then exposes the necrotic and infected bone, employing a series of drill holes to facilitate the excavation of the bone between these holes, ultimately forming an oval window. The extent of bone removal is determined by the severity of the infection. Additionally, a curette may be utilized to clear out any devitalized tissue from the medullary canal. The debridement process continues until healthy bone is reached, indicated by the presence of punctate bleeding on the exposed surface. Following the removal of all compromised tissue, the surgical site is thoroughly irrigated with sterile saline or an antibiotic solution to minimize the risk of further infection. Finally, the wound is loosely closed, and a drain is placed to allow for any potential fluid accumulation post-surgery.
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The procedure described by CPT® Code 23184 is indicated for the treatment of osteomyelitis affecting the proximal humerus. Osteomyelitis is characterized by the infection of the bone, which can lead to necrosis and the formation of abscesses. The following conditions may warrant this surgical intervention:
The procedure for CPT® Code 23184 involves several critical steps to ensure effective treatment of osteomyelitis in the proximal humerus:
After the completion of the procedure, patients can expect a recovery period that may involve monitoring for signs of infection and managing pain. The placement of a drain will help prevent fluid accumulation, which is essential for proper healing. Follow-up appointments will be necessary to assess the surgical site and ensure that the infection has been adequately addressed. Rehabilitation may also be recommended to restore function to the shoulder and arm, depending on the extent of the surgery and the patient's overall health status.
| Short Descr | REMOVE HUMERUS LESION | Medium Descr | PARTIAL EXCISION BONE PROXIMAL HUMERUS | Long Descr | Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), proximal humerus | 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 | 142 - Partial excision 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) | 20702 | Add-on Code MPFS Status: Active Code APC N Manual preparation and insertion of drug-delivery device(s), intramedullary (List separately in addition to code for primary procedure) |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 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). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code 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) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| Pre-1990 | Added | Code added. |
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