Surgical removal of necrotic or sequestered bone from the olecranon process of the elbow, typically performed to address osteomyelitis or a bone abscess.

Verified May 8, 2026 · 6 sources ↓

Medicare: $661.00
Total RVUs: 19.79
Global, days: 90
Region: Elbow

Drawn from CMSAAPCFindacodeMdclarityBonesupport

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 surgical approach to the olecranon (posterior, lateral, etc.) — notes that say 'standard approach' flag on audit.
Document the extent of bony debridement: dimensions of sequestrum removed and whether saucerization or craterization was performed.
Pathology or intraoperative findings must confirm presence of necrotic or infected bone to support osteomyelitis/bone abscess diagnosis.
ICD-10 must specify laterality (right vs. left olecranon) and acuity of osteomyelitis (acute, subacute, chronic) with appropriate M86 subcategory.
Pre-operative imaging (X-ray, MRI, or bone scan) demonstrating sequestrum or abscess cavity should be referenced in the operative note.
Culture results or microbiology reports, if obtained intraoperatively, should be documented and linked to the diagnosis.

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 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 24138 describes a sequestrectomy of the olecranon process — an open procedure in which the surgeon removes dead or infected bone (sequestrum) from the tip of the elbow. The indication is typically osteomyelitis or a bone abscess that has caused a discrete segment of the olecranon to become necrotic and isolated from viable surrounding bone. The surgeon enters the infected area, debrides the sequestrum, and may saucerize or crater the remaining bone to allow drainage and healing.

The 90-day global period means all routine follow-up care, wound checks, and dressing changes through day 90 are bundled into the single fee. Any unrelated E/M visit in that window requires modifier 24. If a staged or planned return to the OR is needed — for example, a second debridement — use modifier 58. An unplanned return for an unrelated elbow problem uses modifier 79.

Site of service matters here. The gap between HOPD and ASC facility payments is substantial; confirm the patient's payer contract and site-of-service rules before scheduling. ICD-10 diagnosis coding must specify laterality and, for osteomyelitis, the organism and acuity (acute vs. chronic) to satisfy medical necessity. Chronic osteomyelitis with sequestrum maps to M86.6x-series codes with a laterality character; confirm the correct subcategory against the operative and pathology findings.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	8.29
Practice expense RVU	9.74
Malpractice RVU	1.76
Total RVU	19.79
Medicare national rate	$661.00
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	$661.00
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 24138 get rejected.

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

Non-specific or missing ICD-10 diagnosis — using an unspecified osteomyelitis code without laterality or acuity triggers medical necessity reviews.
Insufficient documentation of necrotic bone; claims denied when the op note describes only soft-tissue debridement without confirming bony sequestrum.
Global period conflicts — post-op E/M visits billed without modifier 24 when unrelated to the sequestrectomy are auto-denied by most payers.
Missing pre-operative imaging or lab support to establish medical necessity of surgical debridement over conservative management.
Incorrect site-of-service billing — facility fee billed at ASC rate when procedure was performed in an HOPD, or vice versa.

Frequently asked questions

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

01What ICD-10 codes pair with CPT 24138?

Chronic osteomyelitis with sequestrum of the radius and ulna — M86.63x (right) or M86.62x (left) — is the most common pairing. Acute osteomyelitis maps to M86.12x/M86.13x. Bone abscess without osteomyelitis may use M86.66x series. Confirm laterality and acuity; unspecified codes invite medical necessity denials.

02Is modifier 50 appropriate for 24138?

Only if bilateral olecranon sequestrectomies are performed in the same operative session, which is clinically rare. Most payers require LT/RT pair billing instead of modifier 50 for elbow codes — verify your MAC's bilateral billing policy before appending 50.

03Can 24138 be billed with wound debridement codes on the same date?

Generally no. Soft-tissue debridement is considered integral to the sequestrectomy and is not separately reportable on the same date. Appending modifier 59 or XS does not override NCCI bundling rules when the debridement is part of the same surgical field.

04What modifier is correct if the patient returns to the OR two weeks later for a second debridement of the same elbow?

If the second debridement was planned or staged at the time of the original procedure, use modifier 58. If it was unplanned but related to the original infection, use modifier 78. Modifier 79 is for an unrelated return — do not use it for complications or progression of the same osteomyelitis.

05Does the 90-day global period affect antibiotic infusion visits or infectious disease consults?

No. The 90-day global only bundles services by the operating surgeon and their same-group partners related to the surgical procedure. Infectious disease management, IV antibiotic administration, and consults by other physicians are outside the global and bill separately with appropriate E/M or infusion codes.

06Is pre-authorization typically required for CPT 24138?

Most commercial payers require prior authorization for elbow bone excision procedures. Submit with imaging evidence of sequestrum and documented failure or contraindication of conservative management. Medicare does not require prior auth but requires medical necessity documentation supporting surgical intervention.

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 approach to the olecranon, the surgeon's description of the sequestrum (size, extent, appearance), whether saucerization was performed, intraoperative culture collection, and the laterality of the procedure — all from dictation. This prevents the most common audit flag for 24138: an operative note that confirms infection but never explicitly describes necrotic or sequestered bone being excised, which gives payers grounds to downcode or deny the claim.

See how Mira captures CPT 24138 documentation