How To Use CPT Code 27236

CPT 27236 refers to the open treatment of a femoral fracture, proximal end, neck, with internal fixation or prosthetic replacement. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 27236 procedures.

1. What is CPT 27236?

CPT 27236 is a medical procedure code used to describe the open treatment of a femoral fracture, proximal end, neck, with internal fixation or prosthetic replacement. This code is used by medical coders and billers to accurately document and bill for this specific procedure.

2. 27236 CPT code description

The official description of CPT code 27236 is: “Open treatment of femoral fracture, proximal end, neck, internal fixation or prosthetic replacement.”

3. Procedure

The 27236 procedure involves the following steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider makes an incision in the skin over the fractured bone.
3. Subcutaneous tissue is dissected, protecting nerves and vessels.
4. Tissue is separated and muscles are retracted to expose the neck of the femur.
5. The bone is adjusted to reduce the fractured fragments.
6. Internal fixation implants, such as screws, nails, or wires, are used to fix the fracture.
7. If necessary, the provider removes the fracture fragments and places an artificial implant as a replacement of the bone.
8. The wound is closed by suturing the skin layers together.
9. The patient’s leg is placed in a brace for a period of four to six weeks.
10. X-ray examinations may be performed to confirm the reduction of the fracture.

4. Qualifying circumstances

Patients eligible to receive CPT code 27236 services are those who have sustained a femoral fracture, proximal end, neck, and require open treatment with internal fixation or prosthetic replacement. This procedure is typically performed when closed treatment methods are not sufficient or when the fracture is too severe for closed treatment to be effective.

5. When to use CPT code 27236

It is appropriate to bill the 27236 CPT code when a provider performs an open treatment of a femoral fracture, proximal end, neck, with internal fixation or prosthetic replacement. This code should be used when the fracture cannot be effectively treated with closed methods or when the bone is too severely damaged for closed treatment to be successful.

6. Documentation requirements

To support a claim for CPT 27236, the following information should be documented:

• Patient’s medical history and physical examination findings
• Diagnosis of femoral fracture, proximal end, neck
• Indication for open treatment with internal fixation or prosthetic replacement
• Details of the surgical procedure, including the type of fixation or prosthetic used
• Postoperative care instructions and follow-up plan
• Any complications or adverse events encountered during the procedure

7. Billing guidelines

When billing for CPT code 27236, it is important to follow the appropriate guidelines and rules. Some tips and codes that apply to CPT code 27236 include:

• Ensure that the documentation supports the use of CPT 27236 and accurately reflects the procedure performed.
• Verify that the patient’s diagnosis and medical necessity for the procedure are clearly documented.
• Be aware of any payer-specific requirements or guidelines for billing CPT 27236.
• Use appropriate modifiers, if necessary, to accurately describe the procedure and any additional services provided.

8. Historical information

CPT 27236 was added to the Current Procedural Terminology system in 1990. There have been updates to the code since its addition, including a change in the descriptor in 2001. The code has also been added and removed from the Medicare Inpatient Only (IPO) list multiple times, most recently being added back to the list in 2022.

9. Similar codes to CPT 27236

Five similar codes to CPT 27236 and how they differentiate from CPT 27236 are:

1. CPT 27230: Closed treatment of femoral fracture, proximal end, neck, without manipulation. This code is used when the provider performs a closed treatment without manipulation.
2. CPT 27232: Closed treatment of femoral fracture, proximal end, neck, with manipulation, with or without skeletal traction. This code is used when the provider performs a closed treatment with manipulation and may include skeletal traction.
3. CPT 27235: Percutaneous skeletal fixation of femoral fracture, proximal end, neck. This code is used when the provider performs a percutaneous skeletal fixation of the fracture.
4. CPT 27238: Open treatment of femoral fracture, proximal end, neck, with internal fixation, when done for nonunion or malunion. This code is used when the provider performs an open treatment for nonunion or malunion with internal fixation.
5. CPT 27244: Open treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture, with plate/screw type implant, with or without cerclage. This code is used when the provider performs an open treatment of a specific type of femoral fracture with a plate/screw type implant, with or without cerclage.

10. Examples

Here are 10 detailed examples of CPT code 27236 procedures:

1. A patient with a displaced femoral neck fracture requiring open reduction and internal fixation with multiple screws.
2. A patient with a comminuted femoral neck fracture requiring open reduction and prosthetic replacement with a bipolar hemiarthroplasty.
3. A patient with a femoral neck fracture and significant displacement, treated with open reduction and internal fixation using a sliding hip screw.
4. A patient with a femoral neck fracture and severe osteoporosis, treated with open reduction and prosthetic replacement using a total hip arthroplasty.
5. A patient with a femoral neck fracture and failed closed reduction, requiring open reduction and internal fixation with a cannulated screw system.
6. A patient with a femoral neck fracture and associated hip dislocation, treated with open reduction, internal fixation, and hip joint relocation.
7. A patient with a femoral neck fracture and significant bone loss, treated with open reduction and prosthetic replacement using a custom implant.
8. A patient with a femoral neck fracture and nonunion after previous closed treatment, requiring open reduction and internal fixation with a dynamic hip screw.
9. A patient with a femoral neck fracture and associated acetabular fracture, treated with open reduction, internal fixation, and acetabular reconstruction.
10. A patient with a femoral neck fracture and severe hip joint arthritis, treated with open reduction and prosthetic replacement using a total hip arthroplasty with a metal-on-metal bearing surface.