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Official Description

Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); talus or calcaneus

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 28120 involves a partial excision of bone, specifically targeting the talus or calcaneus, which are bones located in the ankle and heel, respectively. This surgical intervention is also known by several terms, including craterization, saucerization, sequestrectomy, or diaphysectomy. The primary indications for this procedure include the treatment of osteomyelitis, which is a serious infection of the bone that can produce pus, and the removal of a bony protuberance, referred to as bossing. The goal of the procedure is to remove infected or necrotic bone tissue to alleviate symptoms and promote healing. Craterization and saucerization techniques are employed to create a shallow depression in the bone surface, facilitating drainage from the infected area. Sequestrectomy specifically targets the excision of necrotic bone that has detached from healthy bone, while diaphysectomy focuses on the removal of infected sections of the long bone shaft. This procedure is critical in managing conditions that compromise bone integrity and function, ensuring that the affected area is cleared of infection and allowing for potential recovery and restoration of normal bone structure.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The procedure associated with CPT® Code 28120 is indicated for specific conditions that necessitate the removal of infected or abnormal bone tissue. The following are the primary indications for performing this procedure:

  • Osteomyelitis - A pyogenic infection of the bone that can lead to the destruction of bone tissue and requires surgical intervention to remove the infected area.
  • Bossing - The presence of a bony protuberance that may require excision to alleviate discomfort or functional impairment.

2. Procedure

The procedure for CPT® Code 28120 involves several detailed steps to ensure the effective removal of infected or necrotic bone tissue. The following outlines the procedural steps:

  • Step 1: Incision and Exposure - The surgeon begins by making an incision in the skin over the site of osteomyelitis or the bony protuberance. This incision is carefully extended through the soft tissue layers to expose the underlying bone.
  • Step 2: Resection of Soft Tissue - Any soft tissue sinus tracts and devitalized soft tissue in the area are resected to ensure a clean surgical field and to facilitate access to the infected bone.
  • Step 3: Bone Exposure - The area of necrotic and infected bone is then exposed, allowing the surgeon to assess the extent of the infection and plan for the removal of affected bone.
  • Step 4: Drilling and Excavation - A series of drill holes are made in the infected bone. The bone between these drill holes is excavated using an osteotome to create an oval window, which allows for the removal of necrotic tissue.
  • Step 5: Excision of Sequestra - Any sequestra, or pieces of necrotic bone that have separated from healthy bone, are excised during this step to ensure complete removal of infected tissue.
  • Step 6: Curettage - A curette may be utilized to remove any remaining devitalized tissue from the medullary canal, further cleaning the surgical site.
  • Step 7: Hemostasis - The debridement continues until punctate bleeding is observed on the exposed bony surface, indicating that healthy tissue has been reached.
  • Step 8: Irrigation - Once all devitalized and infected tissue has been removed, the wound is copiously irrigated with sterile saline or an antibiotic solution to reduce the risk of infection.
  • Step 9: Closure - The surgical wound is then loosely closed, and a drain may be placed to facilitate any potential drainage from the site.
  • Step 10: Excision of Bossing - If a bony protuberance is present, it is exposed and excised using an osteotome to chip away the overgrowth, ensuring a smooth bone surface.

3. Post-Procedure

After the completion of the procedure, post-operative care is essential for optimal recovery. The patient may be monitored for signs of infection or complications at the surgical site. Pain management strategies will be implemented to ensure patient comfort. The surgical area should be kept clean and dry, and any drains placed during the procedure will be monitored for output. Follow-up appointments will be necessary to assess healing and to determine if further interventions are required. Rehabilitation may be recommended to restore function and mobility in the affected area, depending on the extent of the procedure and the patient's overall health status.

Short Descr PART REMOVAL OF ANKLE/HEEL
Medium Descr PARTIAL EXCISION BONE TALUS/CALCANEUS
Long Descr Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); talus or calcaneus
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) 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 2
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)
RT Right side (used to identify procedures performed on the right side of the body)
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)
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
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.
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
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.
50 Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d).
52 Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
54 Surgical care only: when 1 physician or other qualified health care professional performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding modifier 54 to the usual procedure number.
55 Postoperative management only: when 1 physician or other qualified health care professional performed the postoperative management and another performed the surgical procedure, the postoperative component may be identified by adding modifier 55 to the usual procedure number.
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.
62 Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate.
76 Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
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).
81 Minimum assistant surgeon: minimum surgical assistant services are identified by adding modifier 81 to the usual procedure number.
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).
AG Primary physician
AQ Physician providing a service in an unlisted health professional shortage area (hpsa)
CR Catastrophe/disaster related
GA Waiver of liability statement issued as required by payer policy, individual case
GV Attending physician not employed or paid under arrangement by the patient's hospice provider
GW Service not related to the hospice patient's terminal condition
QJ Services/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirements in 42 cfr 411.4 (b)
SG Ambulatory surgical center (asc) facility service
T1 Left foot, second digit
T2 Left foot, third digit
T3 Left foot, fourth digit
T4 Left foot, fifth digit
T5 Right foot, great toe
T6 Right foot, second digit
T7 Right foot, third digit
T8 Right foot, fourth digit
T9 Right foot, fifth digit
TA Left foot, great toe
X4 Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
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