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A sequestrectomy is a surgical procedure specifically designed to address conditions such as osteomyelitis or a bone abscess affecting the forearm and/or wrist. The term "sequestrectomy" refers to the removal of a sequestrum, which is a segment of necrotic, or dead, bone that has detached from the surrounding healthy bone tissue. This detachment often occurs due to infection or other pathological processes that compromise the integrity of the bone. During the procedure, a surgical incision is made through the skin and soft tissue to access the affected area. If the periosteum, which is the dense layer of vascular connective tissue enveloping the bones, is found to be healthy and viable, it is carefully lifted away from the necrotic sequestrum. The surgeon then excises the dead bone, and the elevated periosteum is repositioned to cover the resulting defect in the cortical bone. In cases where the periosteum is not viable and an involucrum—a layer of new bone that forms around the sequestrum—has developed, the necrotic bone is removed while preserving the involucrum. This approach allows for the potential regeneration of new bone within the defect. Finally, the incisions in the soft tissue and skin are sutured closed, and a dressing is applied to protect the surgical site during the healing process.
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The sequestrectomy procedure is indicated for specific conditions that involve the presence of necrotic bone, particularly in the forearm and/or wrist. The following are the primary indications for performing this surgical intervention:
The sequestrectomy procedure involves several critical steps to ensure the effective removal of the necrotic bone and the preservation of surrounding healthy tissue. The following outlines the procedural steps:
After the sequestrectomy procedure, patients can expect a recovery period that may vary depending on the extent of the surgery 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 determine if further interventions are necessary. The application of a dressing helps protect the surgical site and may need to be changed regularly as part of the post-operative care plan.
| Short Descr | REMOVE FOREARM BONE LESION | Medium Descr | SEQUESTRECTOMY FOREARM &/WRIST | Long Descr | Sequestrectomy (eg, for osteomyelitis or bone abscess), forearm and/or wrist | 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 | 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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