Summary & Overview
CPT 23180: Excision of Infected Bone, Proximal Humerus
CPT code 23180 represents excision of infected bone from the proximal humerus, a surgical procedure commonly undertaken for osteomyelitis or localized bone abscess. This code captures a focused operative debridement/partial ostectomy of the top of the upper arm and is clinically important for tracking management of bone infections and related surgical resource use across care settings. Nationally, procedures for osteomyelitis carry implications for hospital utilization, postoperative care, and durable medical equipment and antibiotic stewardship.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for the procedure, typical sites of service, and what benchmarks and policy considerations commonly accompany billing for operative debridement of the proximal humerus. The publication also outlines common billing modifiers and coding considerations where available, payer coverage patterns, and potential documentation elements relevant to claims adjudication. Data not available in the input are noted where applicable. This summary is intended for a national audience of clinicians, coding professionals, and policy analysts seeking clear, actionable information about CPT code 23180 and its place in surgical care for upper-arm bone infection.
Billing Code Overview
CPT code 23180 describes a surgical procedure in which the provider excises a portion of infected bone from the proximal humerus, typically performed for osteomyelitis or a bone abscess. This procedure is a form of operative debridement and partial ostectomy of the upper arm bone.
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Service type: Surgical excision of infected bone (operative debridement/partial ostectomy)
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Typical site of service: Hospital inpatient or outpatient surgical setting, including ambulatory surgery centers when clinically appropriate
Clinical & Coding Specifications
Clinical Context
A 58-year-old male with poorly controlled diabetes presents with chronic right shoulder pain, erythema, and drainage after prior debridement. Imaging (MRI) demonstrates focal osteomyelitis of the proximal humeral metaphysis with sequestrum and adjacent abscess. The orthopedic surgeon schedules operative irrigation and debridement with excision of infected proximal humeral bone to remove devitalized tissue, control infection, obtain cultures, and preserve as much native joint function as possible. The patient is admitted to an inpatient surgical unit for general anesthesia, perioperative antibiotics, and post‑operative monitoring. Intraoperative steps include exposure of the proximal humerus, removal of necrotic bone using rongeurs and curettes, irrigation, culture collection, hemostasis, and wound management with possible drain placement. Postoperative workflow includes antimicrobial therapy guided by cultures, wound checks, physical therapy planning, and documentation of bone excision extent and cultures for coding and billing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, or complexity significantly exceed typical for 23180 due to extensive debridement or difficult exposure. |