How To Use CPT Code 27146

CPT 27146 describes a surgical procedure that involves the cutting of a portion of the iliac, acetabular, or innominate bone in the pelvis. This article will provide an overview of CPT code 27146, including its official description, the procedure itself, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 27146?

CPT 27146 is a code used to describe a surgical procedure in which a qualified healthcare provider cuts a portion of the iliac, acetabular, or innominate bone in the pelvis. This procedure is typically performed to correct deformities or alignment issues in the hip joint. It is important to note that CPT code 27146 should not be used when the provider performs this osteotomy with open reduction of the hip or with femoral osteotomy. Separate codes exist for those scenarios.

2. Official Description

The official description of CPT code 27146 is: ‘Osteotomy, iliac, acetabular or innominate bone.’

3. Procedure

1. In this procedure, the healthcare provider performs an osteotomy by cutting a portion of the iliac, acetabular, or innominate bone in the pelvis.
2. The provider typically makes a straight incision extending from the iliac spine to the inguinal area.
3. After dissecting through the soft tissue, the provider releases the adductor and iliopsoas muscles.
4. Using a Gigli saw or a similar tool, the provider cuts the bone from the sciatic notch to the anterior inferior iliac spine.
5. The entire acetabulum, along with the pubis and ischium, is rotated forward and outward as a unit, with the symphysis acting as a hinge.
6. This rotation flattens the excessively steep acetabular roof, aiming to prevent early osteoarthritis caused by abnormal pressure along the edge of the steep acetabulum.
7. A separate incision is made to obtain a graft from the iliac bone, which is used to fix the osteotomy site.
8. Hemostasis is achieved at the surgical site, and the wound is closed by suturing the soft tissue in layers.
9. The patient is then placed in a hip brace for a period of six weeks to aid in the healing process.

4. Qualifying circumstances

CPT code 27146 is typically used when a patient requires an osteotomy of the iliac, acetabular, or innominate bone to correct deformities or alignment issues in the hip joint. This procedure is commonly performed on children with excessively steep acetabulums to prevent early osteoarthritis. It is important to note that CPT code 27146 should not be used when the provider performs this osteotomy with open reduction of the hip or with femoral osteotomy.

5. When to use CPT code 27146

CPT code 27146 should be used when a qualified healthcare provider performs an osteotomy of the iliac, acetabular, or innominate bone in the pelvis. It is important to ensure that the procedure does not involve open reduction of the hip or femoral osteotomy, as separate codes exist for those scenarios.

6. Documentation requirements

To support a claim for CPT code 27146, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for the osteotomy
• Details of the procedure, including the specific bone(s) involved
• Date of the procedure
• Incision site and approach used
• Specific steps taken during the procedure
• Any additional procedures performed in conjunction with the osteotomy
• Details of any grafts used
• Post-operative care instructions
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT code 27146, ensure that the procedure involves the osteotomy of the iliac, acetabular, or innominate bone in the pelvis. It is important to use the appropriate code based on the specific procedure performed. CPT code 27146 should not be reported with codes for open reduction of the hip or femoral osteotomy. Additional tips for accurate billing may be obtained from the payer or coding guidelines.

8. Historical information

CPT code 27146 was added to the Current Procedural Terminology system on January 1, 1990. It has undergone several changes, including being added to and removed from the Inpatient Only (IPO) list for Medicare. It is important to stay updated with the latest coding guidelines and payer requirements for accurate reporting of CPT code 27146.

9. Examples

1. A qualified healthcare provider performs an osteotomy of the iliac bone to correct a deformity in the hip joint of a pediatric patient.
2. During a surgical procedure, a provider cuts a portion of the acetabular bone to improve alignment in a patient with hip dysplasia.
3. An orthopedic surgeon performs an innominate bone osteotomy to address an alignment issue in the hip joint of an adult patient.
4. A pediatric orthopedic specialist performs a Salter’s osteotomy, cutting the innominate bone, to stabilize the hip in a child with an excessively steep acetabulum.
5. A healthcare provider performs an osteotomy of the iliac bone to correct a deformity in the hip joint caused by a previous injury.
6. During a surgical procedure, a provider cuts a portion of the acetabular bone to address a congenital hip abnormality in an infant.