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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 arm, including the humeral shaft, distal humerus, radial head, neck, or olecranon process. During the operation, a surgical incision is made to access the affected area, allowing the surgeon to carefully elevate the periosteum, which is the layer of connective tissue surrounding 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 and an involucrum, or new bone formation, has developed around the sequestrum, the necrotic bone is removed while preserving the involucrum to facilitate healing. Finally, the incisions are closed, and a dressing is applied to protect the surgical site during the recovery process.
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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. First, a surgical incision is made in the skin, which is carefully extended through the soft tissue to reach the site of the osteomyelitis or bone abscess. This incision allows the surgeon to access the affected area directly. Next, the surgeon evaluates the condition of the periosteum, which is the fibrous tissue covering the bone. If the periosteum is found to be soft and viable, it is gently elevated away from the necrotic sequestrum, exposing the damaged bone beneath. The next step involves the excision of the necrotic bone, which is the primary goal of the procedure. After the sequestrum is removed, the surgeon will assess the periosteum again. If it is still viable, the elevated periosteum is approximated over the cortical bone defect left by the excised sequestrum. However, if the periosteum is not viable and an involucrum has formed around the sequestrum, the necrotic bone is removed while leaving the involucrum intact. This is crucial as the involucrum can facilitate the formation of new bone in the area of the cortical bone defect. Finally, the incisions in the soft tissue and skin are meticulously closed, and a dressing is applied to protect the surgical site and promote healing.
After the sequestrectomy, patients can expect a recovery period that may vary depending on the extent of the procedure and the individual’s overall health. Post-procedure care typically includes monitoring for signs of infection, managing pain, and ensuring proper wound care. Patients may be advised to limit movement of the affected limb to promote healing and prevent complications. Follow-up appointments are essential to assess the healing process and to ensure that the involucrum, if present, is effectively contributing to new bone formation. Rehabilitation may be necessary to restore function and strength to the affected area as healing progresses.
| Short Descr | SEQUESTRECTOMY RADIAL H/N | Medium Descr | SEQUESTRECTOMY RADIAL HEAD OR NECK | Long Descr | Sequestrectomy (eg, for osteomyelitis or bone abscess), radial head or 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) | 1 - Statutory 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 | 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). | LT | Left side (used to identify procedures performed on the left side of the body) |
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| 2023-01-01 | Note | Short description changed. |
| Pre-1990 | Added | Code added. |
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