How To Use CPT Code 27245

CPT 27245 is a code used for the treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fractures with an intramedullary implant. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 27245 procedures.

1. What is CPT 27245?

CPT 27245 is a code used by medical professionals to describe a specific procedure for treating intertrochanteric, peritrochanteric, or subtrochanteric femoral fractures. This procedure involves the use of an intramedullary implant, with or without interlocking screws and/or cerclage, to stabilize the fractured bones.

2. 27245 CPT code description

The official description of CPT code 27245 is: “Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; with intramedullary implant, with or without interlocking screws and/or cerclage.”

3. Procedure

The 27245 procedure involves the following steps:

1. The patient is prepped and anesthetized.
2. The provider makes an incision over the upper end of the femur bone, near the top of the hip.
3. Subcutaneous tissue is dissected, protecting nerves and vessels.
4. Muscles are retracted or detached to expose the fracture.
5. The provider reduces the fractured fragments or dislocated bones to their normal alignment.
6. An intramedullary implant is used to stabilize the reduced fracture fragments.
7. The intramedullary nail is placed through the upper fractured fragment and passed through the medullary canal into the shaft of the femur.
8. Interlocking screws may be drilled through the holes in the nail and into the femoral head.
9. Cerclage, a wire loop or metal band, may be used to hold the fracture fragments in place.
10. The wound is closed by reattaching muscles and suturing tissue layers together.
11. The patient’s leg is placed in a brace or splint for four to six weeks.
12. An X-ray examination may be performed to confirm the reduction of the fracture.

4. Qualifying circumstances

Patients eligible to receive CPT code 27245 services are those with an intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture requiring open treatment with an intramedullary implant. The fracture must be severe enough to warrant surgical intervention and stabilization with an intramedullary implant, with or without interlocking screws and/or cerclage.

5. When to use CPT code 27245

It is appropriate to bill the 27245 CPT code when a provider performs an open treatment of an intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture using an intramedullary implant, with or without interlocking screws and/or cerclage, to stabilize the fractured bones. This code should be used only when the procedure meets the specific criteria outlined in the CPT code description.

6. Documentation requirements

To support a claim for CPT 27245, the following information should be documented:

• Patient’s medical history and physical examination findings
• Diagnosis of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture
• Indication for the open treatment with an intramedullary implant
• Details of the surgical procedure, including the use of interlocking screws and/or cerclage, if applicable
• Postoperative care plan, including the use of a brace or splint and follow-up appointments
• Any complications or adverse events related to the procedure

7. Billing guidelines

When billing for CPT code 27245, it is essential to follow the specific guidelines and rules set forth by the American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS). Ensure that the procedure meets the criteria outlined in the CPT code description and that all necessary documentation is provided to support the claim. Additionally, be aware of any relevant modifiers, such as those indicating bilateral procedures or distinct procedural services, that may apply to the code.

8. Historical information

CPT 27245 was added to the Current Procedural Terminology system on January 1, 1993. Since then, there have been several updates to the code, including changes to the descriptor in 2003 and 2007. In 2017, the code was added to the Inpatient Only (IPO) list for Medicare, removed in 2021, and added back to the IPO list in 2022.

9. Similar codes to CPT 27245

Five similar codes to CPT 27245 and how they differ are:

• CPT 27244: Involves the use of a plate and screw type implant, rather than an intramedullary implant, for the treatment of the same types of femoral fractures.
• CPT 27236: Describes an open treatment of a femoral fracture, proximal end, neck, internal fixation, or prosthetic replacement.
• CPT 27238: Refers to an open treatment of a femoral fracture, proximal end, neck, with internal fixation and femoral head prosthesis.
• CPT 27235: Involves a percutaneous treatment of a femoral fracture, proximal end, neck, with or without internal fixation.
• CPT 27248: Describes an open treatment of a femoral shaft fracture with plate and screws, with or without cerclage.

10. Examples

Here are 10 detailed examples of CPT code 27245 procedures:

1. A 65-year-old patient with an intertrochanteric femoral fracture treated with an intramedullary nail and interlocking screws.
2. A 45-year-old patient with a peritrochanteric femoral fracture treated with an intramedullary implant and cerclage.
3. A 70-year-old patient with a subtrochanteric femoral fracture treated with an intramedullary nail without interlocking screws or cerclage.
4. A 55-year-old patient with an intertrochanteric femoral fracture treated with an intramedullary implant and both interlocking screws and cerclage.
5. A 60-year-old patient with a peritrochanteric femoral fracture treated with an intramedullary nail and interlocking screws, but no cerclage.
6. A 50-year-old patient with a subtrochanteric femoral fracture treated with an intramedullary implant, interlocking screws, and cerclage.
7. A 75-year-old patient with an intertrochanteric femoral fracture treated with an intramedullary nail and cerclage, but no interlocking screws.
8. A 40-year-old patient with a peritrochanteric femoral fracture treated with an intramedullary implant without interlocking screws or cerclage.
9. A 68-year-old patient with a subtrochanteric femoral fracture treated with an intramedullary nail, interlocking screws, and no cerclage.
10. A 72-year-old patient with an intertrochanteric femoral fracture treated with an intramedullary implant, no interlocking screws, and cerclage.