Summary & Overview
CPT 25145: Removal of Separated Dead Bone, Forearm or Wrist
CPT code 25145 denotes a surgical intervention to open the forearm or wrist and remove a separated, nonviable bone fragment. This procedure addresses necrotic or devitalized bone that may cause persistent pain, infection risk, or impaired function. Nationally, accurate coding of this procedure affects surgical case classification, claims adjudication, and appropriate billing for orthopedic and hand surgery services.
Key payers commonly involved in reimbursement for this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage policies and prior authorization requirements vary by payer and plan; clinicians and billing teams must map clinical indications to payer-specific surgical criteria.
Readers will find a concise overview of the clinical intent and typical service setting for 25145, a summary of which payers are included in benchmarking discussions, and guidance on what to expect in related content: procedure-level benchmarks, common billing considerations, and clinical context for use. Data not available in the input will be noted where applicable. This national-level summary is intended to inform coding, billing, and administrative staff about the procedural definition and where deeper payer-specific and benchmark analyses can be found.
Billing Code Overview
CPT code 25145 describes a surgical procedure in which the provider makes an incision in the forearm or wrist to remove a separated, nonviable fragment of bone (sequestrectomy/removal of dead bone). Service type: Surgical debridement/orthopedic excision of necrotic bone. Typical site of service: Operating room or ambulatory surgical center involving the wrist or forearm region.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 45-year-old with a history of distal radius fracture complicated by nonunion and sequestrum formation presenting with persistent wrist pain, local tenderness, occasional drainage, and limited forearm motion. Imaging (plain radiographs and CT) identifies a small separated fragment of devitalized bone in the distal radius or proximal carpal row consistent with a sequestrum. The clinical workflow includes preoperative evaluation (history, focused musculoskeletal exam, imaging, and infection workup including inflammatory markers and possible wound culture), informed consent discussing risks of open removal and potential need for internal fixation or bone grafting, perioperative antibiotics if infection suspected, regional or general anesthesia, a sterile open approach to the wrist/forearm, debridement and removal of the separated dead bone fragment, irrigation, hemostasis, possible intraoperative cultures, and closure with appropriate immobilization (splint or cast). Postoperative care includes wound checks, pain control, activity restrictions, physical therapy as indicated, and follow-up imaging to confirm resolution and bone healing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than typically required (extensive debridement, prolonged dissection). |