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The procedure described by CPT® Code 23935 involves a deep incision that opens the bone cortex, specifically targeting areas such as the humeral shaft, distal humerus, radial head or neck, or the olecranon process. This surgical intervention is primarily performed to address conditions like osteomyelitis, which is an infection of the bone, or a bone abscess, which is a localized collection of pus within the bone. The process begins with making an incision in the skin, which is then extended through the soft tissue that covers the infected bone area. Following this, the periosteum, which is the dense layer of vascular connective tissue enveloping the bones, is carefully elevated to access the underlying bone. A small section, referred to as a button of cortical bone, is removed to expose the bone marrow. This exposure is crucial as it alleviates the pressure that may have built up due to inflammation within the bone marrow, thereby preventing any further restriction of blood flow to the infected area. In cases where pus is present, the initial opening may be enlarged using surgical instruments such as a chisel or gouge, allowing for better drainage and access along the bone for a distance of one to two inches. If the infection has spread to the epiphysis, which is the end part of a long bone, a portion of the epiphyseal cortex may also be excised to ensure complete drainage of the abscess. This procedure is essential for treating severe bone infections and facilitating recovery by removing infected tissue and allowing for proper healing of the bone.
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The procedure associated with CPT® Code 23935 is indicated for specific conditions that affect the bone, particularly in the humerus or elbow region. The following are the primary indications for performing this procedure:
The procedure begins with the surgeon making a deep incision in the skin over the affected area, which is typically located on the humeral shaft, distal humerus, radial head or neck, or olecranon process. This incision is carefully extended through the soft tissue layers to reach the periosteum, the protective membrane surrounding the bone. Once the periosteum is accessed, it is elevated to expose the underlying bone surface. The surgeon then removes a small button of cortical bone, which is the outer layer of the bone, to gain access to the bone marrow beneath. This step is critical as it allows for the drainage of any infected material and relieves pressure caused by inflammation within the bone marrow. If the procedure reveals the presence of frank pus, the surgeon may need to enlarge the initial opening. This is accomplished using specialized instruments such as a chisel or gouge, which are used to extend the incision along the bone for a distance of one to two inches. This extension facilitates better drainage of the abscess and ensures that all infected material is adequately removed. In cases where the infection has affected the epiphysis, the surgeon may also excise a section of the epiphyseal cortex to ensure complete access to the infected area. The overall goal of this procedure is to effectively drain the abscess and treat the underlying infection, promoting healing and recovery of the bone.
After the completion of the procedure, appropriate post-operative care is essential to ensure proper healing and recovery. The surgical site will typically be monitored for signs of infection, and the patient may be prescribed antibiotics to combat any residual infection. Pain management strategies will also be implemented to address discomfort following the incision and drainage. The patient may be advised to limit movement of the affected arm to promote healing and prevent complications. Follow-up appointments will be necessary to assess the healing process and to determine if further interventions are required. Additionally, the healthcare provider will provide specific instructions regarding wound care and any restrictions on physical activity to support optimal recovery.
| Short Descr | INC DP OPN B1 CRTX HUM/ELBW | Medium Descr | INC DEEP W/OPENING BONE CORTEX HUMERUS/ELBOW | Long Descr | Incision, deep, with opening of bone cortex (eg, for osteomyelitis or bone abscess), humerus or elbow | 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) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | 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 | 2 | 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) | 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) |
| 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.) | 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) | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | 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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| 2023-01-01 | Note | Short description changed. |
| Pre-1990 | Added | Code added. |
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