Surgical removal of a sequestrum (necrotic bone fragment) from the scapula, typically performed to treat chronic osteomyelitis or a bone abscess of the shoulder blade.

Verified May 8, 2026 · 6 sources ↓

Medicare: $545.77
Total RVUs: 16.34
Global, days: 90
Region: Shoulder

Drawn from AAPCFindacodeCMS

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 6 cited references ↓

Operative note must name the specific bone operated on — 'scapula' explicitly, not 'shoulder' or 'posterior thorax'
Document the indication: chronic osteomyelitis, bone abscess, or both, with supporting imaging or culture results
Describe the sequestrum: size, location on the scapula, degree of necrosis, and how it was excised
Record all inclusive components performed: debridement extent, antibiotic irrigation, drain placement, and wound closure technique
If antibiotic beads or a bead pouch were used, note that in the operative report — it affects post-op management documentation
Pre-op diagnosis must include an ICD-10 osteomyelitis code (e.g., M86 series) or bone abscess code tied to the scapula

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 51 Multiple procedures 52 Reduced services 58 Staged or related 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 23172 covers open excision of a sequestrum — a segment of dead, devitalized bone — from the scapula. The indication is almost always chronic osteomyelitis or a bone abscess that has failed conservative management. The surgeon dissects down to the scapula, extracts the necrotic fragment, debrides surrounding infected or dead tissue, irrigates the site with antibiotic solution, places a drain, and closes. All of that is bundled into 23172 — you do not separately bill incision and drainage, debridement, or irrigation performed at the same site.

Code selection in this family turns entirely on anatomy. Osteomyelitis involving the clavicle goes to 23170; the scapula to 23172; the humeral head to surgical neck to 23174. Billing the wrong code for the wrong bone is the most common coding error in this group. Per AAOS guidance, codes 23030, 23031, 23035 (incision and drainage), 23180/23182/23184 (partial excision), 23040/23044/23101/23106 (arthrotomy), and 23700 (manipulation) are all inclusive components — do not unbundle them.

The 90-day global period applies. Post-op visits, wound checks, drain management, and dressing changes through day 90 are included. Anything unrelated to the osteomyelitis or its surgical management requires modifier 24. If the same surgeon addresses an unrelated shoulder problem during a separate encounter in the global window, modifier 79 applies.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	7.13
Practice expense RVU	7.71
Malpractice RVU	1.5
Total RVU	16.34
Medicare national rate	$545.77
Global period	90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$545.77
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI J8) Ambulatory surgical center (freestanding)	$2,171.33

Common denial reasons

The recurring reasons claims for CPT 23172 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Wrong code for the bone: billing 23172 when the operative note describes the clavicle (23170) or humeral head (23174)
Unbundling denied: separately billing I&D codes (23030, 23031, 23035) or partial excision codes (23182) for work already included in 23172
Lack of medical necessity: claim submitted without documented imaging, prior conservative treatment failure, or culture/pathology confirming osteomyelitis or bone abscess
Global period conflict: post-op E&M visit billed without modifier 24 when payer records show active 90-day global
Site not specified in documentation: operative note says 'shoulder' without naming the scapula, causing payer to reject anatomic specificity requirement

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01Can I bill 23182 (partial excision of scapula) alongside 23172 for the same operative session?

No. Per AAOS guidance, partial excision codes including 23182 are inclusive components of 23172. Billing both for the same site on the same date will trigger an NCCI bundle denial.

02The surgeon also drained a soft tissue abscess adjacent to the scapula during the same procedure. Do I add an I&D code?

No. Incision and drainage of soft tissue in the same area (23030, 23031, 23035) is included in 23172. Only bill separately if the I&D was performed at a clearly distinct anatomic site with separate documentation supporting a distinct service.

03What is the global period for 23172, and what does it cover?

23172 carries a 90-day global period. That includes the day before surgery, the procedure day, and all routine post-op care through day 90 — wound checks, drain removal, dressing changes. Unrelated services in that window need modifier 24 or 79.

04How do I pick between 23170, 23172, and 23174?

The deciding factor is which bone the sequestrum is in: clavicle = 23170, scapula = 23172, humeral head to surgical neck = 23174. The operative note must name the specific bone — 'shoulder' alone is insufficient for code selection and will flag in audit.

05Is modifier 22 ever appropriate for 23172?

Yes, when the procedure is substantially more work than typical — for example, extensive scapular involvement, severe scarring from prior infections, or unusually complex debridement. Documentation must describe the added complexity explicitly; a routine note with modifier 22 appended will be downgraded or denied.

06Can a PA or NP bill 23172, or does the surgeon have to perform it?

A physician must perform the procedure. If a qualified non-physician practitioner assists, bill the assisting provider under modifier AS. Independently billing 23172 under a PA or NP for the primary procedure is not appropriate.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures the specific bone name (scapula), sequestrum size and location, debridement extent, antibiotic irrigation, drain placement, and wound closure from the surgeon's dictation — populating the operative note fields that payers audit when deciding between 23170, 23172, and 23174. That anatomic specificity prevents the most common denial in this code family: billing the wrong sequestrectomy code because the note said 'shoulder' instead of naming the bone.

See how Mira captures CPT 23172 documentation