Summary & Overview
CPT 23172: Excision of Sequestrum From Scapula
CPT code 23172 denotes surgical removal of a sequestrum from the scapula — a targeted orthopedic procedure to excise dead bone commonly associated with chronic osteomyelitis. Nationally, this code is relevant to surgical and infectious disease care pathways and affects hospital and ambulatory surgery billing for orthopedic services. Coverage and payment practices for 23172 influence resource use for complex infection management and operative workflows.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The review highlights typical sites of service, common clinical indications, and the billing context for excision of necrotic bone in the shoulder region.
Readers will find benchmarks for utilization and reimbursement patterns where available, summaries of payer coverage considerations, and clinical context explaining when the procedure is used. The material also addresses coding relationships and common operational factors relevant to hospitals and surgical centers. Data not available in the input is identified directly where applicable.
Billing Code Overview
CPT code 23172 describes the surgical excision of a sequestrum — a fragment of dead bone — from the scapula (shoulder blade). This procedure addresses nonviable bone often resulting from chronic osteomyelitis or other bone infection processes.
-
Service type: Surgical debridement/excision of necrotic bone
-
Typical site of service: Ambulatory surgical center or inpatient/outpatient operating room for orthopedic surgery
Clinical & Coding Specifications
Clinical Context
A 52-year-old male presents with chronic right shoulder pain, localized swelling, and intermittent drainage after a prior episode of osteomyelitis. Imaging with radiographs and CT demonstrates a sequestrum within the right scapula. The orthopedic surgeon schedules a surgical excision of the sequestrum under general anesthesia. Preoperative workflow includes history and physical, review of prior microbiology, perioperative antibiotics tailored to culture results, and informed consent for debridement of devitalized bone. Intraoperative steps include incision and exposure of the scapular region, identification and removal of the devitalized bone fragment (23172), irrigation, possible placement of local antibiotic delivery (e.g., beads), and wound closure with or without drainage. Postoperative care includes pain control, wound monitoring, continued targeted antibiotics, follow-up imaging as indicated, and outpatient wound checks until healing is confirmed.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default — no modifier | When no additional modifier applies |
22 | Increased procedural services |