CPT Code 24138: Sequestrectomy of the olecranon process

Key takeaways

CPT Code 24138 describes a sequestrectomy of the olecranon process, performed for osteomyelitis or bone abscess of the elbow.

It sits in the Excision Procedures on the Humerus and Elbow subsection, and it is billable in facility and non-facility settings.

Diagnosis codes come from the M86 osteomyelitis family, and the olecranon sits under the radius and ulna site, not the humerus.

A missing LT or RT laterality modifier is the most common reason a 24138 claim comes back denied.

Practice management software like Pabau tracks claim status and reconciles payments, so a denied 24138 claim does not sit unnoticed.

CPT Code 24138: Definition and clinical description

CPT Code 24138 covers a sequestrectomy of the olecranon process, performed for osteomyelitis or bone abscess. The American Medical Association publishes the long descriptor as Sequestrectomy (eg, for osteomyelitis or bone abscess), olecranon process.

The short descriptor on remittance notices is Sequestrectomy olecrn proces. The olecranon process is the bony point at the back of the elbow. It is the tip that touches the table when you rest your arm on it.

Sequestrectomy means surgical removal of a sequestrum. That is the dead or infected bone that separates from healthy bone while osteomyelitis runs its course.

This code sits in the Excision Procedures on the Humerus and Elbow subsection of the musculoskeletal CPT system, which runs from 24065 to 24155. It is a billable surgical code in both facility and non-facility settings.

Procedure overview: sequestrectomy of the olecranon process

Osteomyelitis of the olecranon is uncommon but serious. It usually follows trauma or elbow surgery, or the infection reaches the bone through the bloodstream. When the bone stays infected, necrotic tissue separates from healthy bone and forms a sequestrum. Left in place, that sequestrum keeps the infection going.

The procedure involves surgical exposure of the olecranon, removal of the dead or infected bone segment, and debridement of the surrounding soft tissue. Sports medicine practices see this in patients with prior trauma or open wounds. A bone abscess, where pus collects inside the bone without a full sequestrum, is also captured by this code.

For billing, what matters is anatomy. CPT Code 24138 belongs to the olecranon process alone. A sequestrectomy at the head or neck of the radius maps to 24136 instead. The operative note has to name the olecranon for this code to hold up in review.

ICD-10 diagnosis codes used with CPT Code 24138

Every claim for CPT Code 24138 needs an ICD-10 diagnosis code that shows medical necessity. The primary codes come from the M86 osteomyelitis family. Payers read the procedure code against the diagnosis code, so a vague or mismatched code is a common denial trigger.

The site character is where these codes go wrong. In the M86 family, one digit fixes the site and the next fixes the side. Radius and ulna codes carry a 3 in the site position, while humerus codes carry a 2.

The olecranon is part of the ulna, so the radius and ulna codes are the ones to use. A humerus code on an olecranon procedure does not match the operative note. A broad code such as M89.9 is too vague to support surgery. A traumatic fracture code such as S52.022E will not show medical necessity on its own either.

Always use the most specific code available. Payer policies often ask for a chronic or subacute osteomyelitis code before they will accept surgery over conservative treatment. Confirm the code set for the service year with the AAPC crosswalk.

Modifiers that apply to 24138

Modifier choice is where 24138 claims most commonly run into trouble. Medicare and most commercial payers require the laterality modifiers LT and RT to show which arm was operated on. Submitting without one is a top denial reason for this code.

NCCI bundling note: Before applying modifier 59 to override a bundling edit, confirm the edit against the CMS National Correct Coding Initiative files. Using modifier 59 to bypass a bundle that applies is an audit risk.

How Medicare pays for 24138

Medicare payment for 24138 is published each year in the Medicare Physician Fee Schedule (MPFS). Rates vary by geographic region, facility type, and the year’s conversion factor. Check current rates with the CMS lookup tool before quoting figures to referring doctors or patients.

The table below reflects the general Medicare payment structure for 24138. Dollar amounts change each year with CMS rulemaking, so confirm them for the service year on the claim.

The 90-day global period covers the surgeon’s routine post-operative visits. Therapy delivered by a physical therapy practice is billed on its own, starting with an evaluation code such as 97161.

RVU breakdown

Relative Value Units (RVUs) drive the Medicare payment calculation. The three components are work, practice expense, and malpractice. The formula is Total RVU x Geographic Adjustment Factor (GPCI) x Conversion Factor = Payment. Pull current-year values for your locality from the FastRVU lookup tool.

Documentation requirements for the operative note

Incomplete operative notes are the most preventable cause of 24138 denials. Documentation standards for surgical codes call for elements that a basic operative report leaves out. Payers running pre-payment or post-payment review look for all of the following.

• Diagnosis and clinical necessity: The record must establish osteomyelitis or bone abscess at the olecranon. Supporting imaging and lab proof of infection belong in the file where they apply.
• Anatomical detail: The operative note must name the olecranon process as the operative site. “Elbow surgery” or “bone debridement” is not enough. Use the anatomical term in the operative report.
• Procedure description: Document the surgical approach, the extent of necrotic or sequestrum tissue removed, and any intraoperative cultures taken. Payers look for proof that a sequestrectomy, not just a debridement, was performed.
• Pathology or culture reports: Cultures or pathology confirming osteomyelitis carry real weight, and they often decide a medical necessity appeal.
• Conservative treatment history: Antibiotic treatment that failed, or a clinical reason conservative management was not the right choice, explains why surgery was necessary.
• Laterality: The operative note, consent form, and anesthesia record must agree on whether the left or right olecranon was treated. Any disagreement between them triggers a claim hold.

Keeping operative note forms in one place in the practice management system cuts laterality errors and missing elements at billing. That matters most for a practice billing across several surgical codes. HIPAA-compliant records also have to stay easy to find for audits, whatever the care setting.

Digital forms remove the reliance on paper forms that lack code-specific fields. Every record is time-stamped and complete before the claim leaves the practice.

Common billing errors and denial reasons

Claims for 24138 fail in a few common ways. Most of them are avoidable with a short pre-submission checklist.

Related CPT codes at the elbow and humerus

CPT Code 24138 belongs to a family of excision and sequestrectomy codes covering the elbow and humerus. Coders research them together because the operative site decides which one applies. Other upper-extremity codes such as 25110 and 23605 turn on the same detail in the note.

24136 versus 24138 is the most common confusion point. Both describe a sequestrectomy at the elbow. The difference is anatomical. 24136 covers a sequestrum at the radial head or neck, and 24138 covers one at the olecranon.

An operative note that says only “elbow sequestrectomy” forces the coder to pick between them without proof. Either choice then carries audit risk. If the surgeon took bone for diagnosis and removed no sequestrum, the open bone biopsy codes such as 20245 are the ones to check.

How practice management software simplifies 24138 billing

Orthopedic surgical codes like 24138 fail in specific places. The anatomical detail gets lost between the operative note and the charge, the laterality modifier goes missing, and the denial only shows up weeks later. A practice management platform catches each of those at a different point in the billing cycle.

• Claim status tracking: Pabau’s claims management software shows where every claim sits, from pending and submitted through to processing, paid, or error. A 24138 claim that errors out is visible the same day.
• Validation before submission: Claims are pre-filled from the patient record and run through validation checks before they go out. Fewer of them come back over something the practice could have corrected first.
• Payment reconciliation: Payments are matched back against the claims that produced them. A short-paid 24138 stands out against the Medicare amount you expected.
• Operative note forms: Procedure-specific forms prompt for the anatomical site, the extent of tissue removed, and the intraoperative findings. The note then supports the code you assigned, not just the code family.
• Automated follow-up: Pabau’s automated workflows handle the chasing around a claim. They can request a missing document or raise a task on one that has gone unpaid.

Keeping the records and the billing in one practice management platform removes the hand-offs where code-specific errors creep in. For a practice billing orthopedic surgery at volume, that shows up as fewer denials and less rework.

Track every 24138 claim through to payment

Pabau's claims management tools show where each claim sits, check it before submission, and reconcile the payment when it lands. Denials surface in days, not at month end.

Book a demo

Conclusion

CPT Code 24138 is a specific code, and its billing problems are specific too. The operative note has to name the olecranon. The laterality modifier is not optional for Medicare, and the diagnosis code has to sit at the radius and ulna site.

The distinction from 24136 is the biggest single source of code choice errors, and it costs nothing to avoid. Ask the surgeon to name the bone in the note, and the coder never has to guess which of the two codes the record supports.

That makes this a habit in the operative note, not just in billing. Book a demo to see how Pabau keeps the operative note and the claim together for surgical practices.

Continue your research

Coding another upper-limb infection case? 26080 covers arthrotomy with exploration or drainage at the interphalangeal joint.

Fracture on the radial side instead? S52.131B is the diagnosis code for an open displaced fracture of the right radial neck.

Documenting a bone that has not healed? S52.209K covers an ulna shaft fracture that has gone to nonunion.

Planning soft-tissue coverage after debridement? 14041 walks through adjacent tissue transfer billing and what to document.

Frequently asked questions