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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. This procedure is specifically indicated for conditions such as osteomyelitis, an infection of the bone, or a bone abscess, which is a localized collection of pus within the bone. The procedure can be performed on various parts of the humerus, including the shaft or distal humerus, as well as other areas such as the radial head or neck and the olecranon process. The surgical approach involves making an incision through the skin and soft tissue to access the affected area. If the periosteum, the layer of tissue covering the bone, is healthy, it is carefully lifted away from the sequestrum to allow for the excision of the necrotic bone. After the sequestrum is removed, the periosteum is repositioned over the resulting defect in the cortical bone. In cases where the periosteum is not viable and an involucrum, which is a layer of new bone formation, has developed around the sequestrum, the necrotic bone is excised while leaving the involucrum intact to promote healing. Finally, the incisions in the soft tissue and skin are sutured closed, and a dressing is applied to protect the surgical site.
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The sequestrectomy procedure is indicated for the following conditions:
The sequestrectomy procedure involves several critical steps to ensure the effective removal of the necrotic bone.
Post-procedure care involves monitoring the surgical site for signs of infection and ensuring proper healing. Patients may be advised on activity restrictions to allow for recovery. Follow-up appointments are typically scheduled to assess the healing process and to determine if any further interventions are necessary. Pain management may also be addressed as part of the post-operative care plan.
| Short Descr | SEQUESTRECTOMY SHFT/DSTL HUM | Medium Descr | SEQUESTRECTOMY SHAFT/DISTAL HUMERUS | Long Descr | Sequestrectomy (eg, for osteomyelitis or bone abscess), shaft or distal 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) | 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 | 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) | 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.) | 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 | 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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| 2023-01-01 | Note | Short description changed. |
| Pre-1990 | Added | Code added. |
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