Incision and drainage of an infected or inflamed bursa located in the upper arm or elbow region.

Verified May 8, 2026 · 7 sources ↓

Medicare: $323.99
Total RVUs: 9.7
Global, days: 10
Region: Elbow

Drawn from MdclarityAAPCThrivemedicalbillingFindacodeNIH

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Confirm the procedure was incision and drainage, not simple aspiration or excision — operative note must describe the incision made and bursal contents evacuated
Document the specific bursa involved (e.g., olecranon bursa) and anatomical location in the upper arm or elbow region
Record clinical indication — infection, inflammation, or acute bursitis — with supporting exam findings and any prior conservative treatment
Note laterality explicitly (left or right elbow/upper arm) in both the operative report and procedure note
If modifier 22 is appended, document the specific factors causing substantially increased complexity (e.g., extensive infection, loculations, dense adhesions)
If an E/M is billed same-day with modifier 25, document the separately identifiable medical decision-making beyond the pre-procedure assessment

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 25 Significant separate E/M 50 Bilateral procedure 51 Multiple procedures 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 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 7 cited references ↓

CPT 23931 covers surgical incision and drainage of a bursa in the upper arm or elbow area — most commonly the olecranon bursa at the posterior elbow. Use this code when the procedure involves opening and draining the bursa, not simply aspirating it. Simple aspiration or injection of the olecranon bursa belongs under 20605 (without ultrasound) or 20606 (with ultrasound guidance). If the surgeon excises the bursa entirely, that's 24105, which carries a 90-day global — a critical distinction from 23931's 10-day global.

The 10-day global period includes the day of surgery plus routine follow-up through day 10. Any E/M service on the day of surgery requires modifier 25 if it reflects a separately identifiable decision beyond the procedure itself. Repeat drainage by the same physician on the same day takes modifier 76; by a different physician, modifier 77. If the patient returns within the global window for a related unplanned procedure, append modifier 78. An unrelated procedure in the same window takes modifier 79.

Laterality matters here: append RT or LT for every claim. Bilateral olecranon bursa I&D in a single session is uncommon but does occur; use modifier 50 and confirm payer policy before billing. NCCI edits may bundle 23931 with same-day aspiration codes — if both are genuinely distinct procedures, modifier 59 is the unbundling mechanism, but document the separate clinical indication clearly.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	1.79
Practice expense RVU	7.56
Malpractice RVU	0.35
Total RVU	9.7
Medicare national rate	$323.99
Global period	10 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	$323.99
HOPD (APC 5072) Hospital outpatient department	$1,687.37
ASC (PI A2) Ambulatory surgical center (freestanding)	$742.04

Common denial reasons

The recurring reasons claims for CPT 23931 get rejected.

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

Missing laterality — RT or LT omitted, triggering edit or payer rejection
Aspiration coded as 23931 — payers differentiate needle aspiration (20605/20606) from surgical I&D; conflating the two draws downcodes or denials
23931 bundled with same-day 20605 or 20606 without modifier 59 and a documented distinct clinical rationale
E/M billed same-day without modifier 25, denied as included in the 10-day global surgical package
23931 billed when excision was actually performed — payers audit operative notes and recode to 24105, triggering a 90-day global recalculation

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What's the difference between 23931 and 20605 for an olecranon bursa?

20605 is needle aspiration of an intermediate bursa — no incision. 23931 requires a surgical incision to open and drain the bursa. Billing 23931 for a needle aspiration will draw a downcode or denial on audit.

02When should I use 23931 vs. 24105 for olecranon bursa work?

23931 is I&D only — drain and debride, bursa left in place. 24105 is complete excision of the olecranon bursa. The global periods differ significantly: 23931 is 10 days, 24105 is 90 days. Code based on what the operative note actually describes.

03Can I bill 23931 and 20605 together on the same day?

NCCI edits may bundle them. If both were genuinely distinct procedures with separate clinical indications, modifier 59 is the unbundling tool — but the operative note must document separate sites or separate rationale clearly, or the claim won't survive audit.

04What global period applies to 23931?

10-day global. That covers the surgery day and routine post-op care through day 10. Any unrelated E/M in that window needs modifier 24; a same-day separately identifiable E/M needs modifier 25.

05Is bilateral olecranon bursa I&D billed with modifier 50?

Yes — append modifier 50 when both sides are drained in the same session. Payer policies on bilateral reimbursement vary, so verify before submitting. Some payers want LT and RT on separate lines rather than modifier 50 on a single line.

06The patient returned within 10 days for repeat drainage — how do I bill?

If it's a planned staged procedure or unrelated, use modifier 79. If it's an unplanned return for a related complication (e.g., re-accumulation of infected fluid), use modifier 78. Do not invert these — modifier 78 is for unplanned related returns; 79 is for unrelated procedures in the global window.

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 procedure type (incision vs. aspiration vs. excision), the specific bursa and anatomical site, laterality, and the clinical indication from dictation. It flags when operative language suggests excision rather than I&D — preventing a 23931 claim that should be 24105 — and prompts for modifier 25 documentation when an E/M is dictated on the same date.

See how Mira captures CPT 23931 documentation