Orthopedic Coding Alert

Question: For a patient with of chronic osteomyelitis in their shoulder, my orthopedist performed a sequestrectomy on the clavicle. Since the surrounding tissue was infected, should I also report a drainage code?

Georgia Subscriber

Answer: No, you should only use code 23170 (Sequestrectomy [e.g., for osteomyelitis or bone abscess], clavicle). The operative report should note that the removal of the infected section of the bone was followed by a debridement and irrigation. For cases when this is document, 23170 is sufficient enough so you won’t have to report any further drainage.

The reason no further codes are need is because a sequestrectomy inherently involves the debridement and irrigation of the site after the removal of the fragment. The surgeon dissects to the bone and reaches the sequestrum. After extracting the sequestrum, typically the surgeon will debride the surrounding dead or infected areas. The area will be irrigated with antibiotic solution, a drain is inserted, and the incision is closed.  

The debridement and irrigation process is also included in the two similar sequestrectomy codes: 23172 (Sequestrectomy [e.g., for osteomyelitis or bone abscess], scapula) and 23174 (Sequestrectomy [e.g., for osteomyelitis or bone abscess], humeral head to surgical neck).