Summary & Overview
CPT 23174: Excision of Sequestrum, Proximal Humerus
CPT code 23174 defines the surgical excision of a sequestrum from the proximal humerus — removal of dead bone typically related to osteomyelitis. This procedure is important nationally because it addresses persistent bone infection that can lead to chronic morbidity, prolonged antibiotic use, and repeat hospital care if not definitively managed. Insurers and hospitals monitor utilization and appropriate setting of care for these procedures as part of efforts to reduce complications and downstream costs.
Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context for the procedure, typical sites of service, and national relevance. The publication summarizes benchmarks where available, common billing considerations, and policy updates that affect coverage and site-of-service decisions. It highlights how the procedure fits into care pathways for osteomyelitis and the implications for utilization management, bundled payments, and quality measurement.
This executive summary provides a concise reference for clinicians, coding professionals, and policy analysts seeking to understand the clinical intent and payer landscape for CPT code 23174 at a national level.
Billing Code Overview
CPT code 23174 describes the excision of a sequestrum — a dead fragment of bone — from the proximal humerus (near the top of the upper arm bone). This procedure is typically performed when bone infection (osteomyelitis) leads to nonviable bone that must be removed to control infection and promote healing.
Service type: surgical debridement/excision of sequestrum
Typical site of service: operating room or ambulatory surgery center, most often with the patient under regional or general anesthesia. If clinically appropriate, select outpatient surgical settings may be used.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with chronic osteomyelitis of the proximal humerus presenting with persistent pain, localized swelling, drainage, and episodic fever despite antibiotic therapy. Prior imaging (plain radiographs, CT, or MRI) demonstrates a sequestrum—a well‑demarcated fragment of necrotic bone—near the humeral head. The orthopedic surgeon elects to perform surgical excision of the sequestrum under general or regional anesthesia.
Preoperative workflow includes history and physical, review of imaging, perioperative labs, and culture-directed antibiotics when indicated. Intraoperative steps involve exposure of the proximal humerus, debridement of infected soft tissue, identification and excision of the sequestrum (23174), irrigation, possible placement of antibiotic cement or drains, and obtaining intraoperative cultures and specimens for pathology. Postoperative care involves pain control, continued targeted antibiotics based on cultures, wound care, and outpatient follow-up with repeat imaging and clinical assessment to ensure resolution of infection and preservation of shoulder function.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when intraoperative work is substantially greater than usual due to extensive infection or additional debridement beyond standard sequestrum excision. |