How To Use CPT Code 27158

CPT 27158 describes a surgical procedure that involves a pelvic osteotomy, specifically performed bilaterally. This article will provide an overview of CPT code 27158, 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 27158?

CPT 27158 is a code used to describe a surgical procedure known as a pelvic osteotomy. This procedure involves the incision and modification of the pelvic bones to correct alignment problems or congenital malformations. It is typically performed bilaterally, meaning on both sides of the pelvis. The purpose of this procedure is to stabilize the hip joint and restore its normal shape and function. It is commonly performed in young children who have pelvic deformities from birth.

2. Official Description

The official description of CPT code 27158 is: ‘Osteotomy, pelvis, bilateral (eg, congenital malformation).’ This code specifically refers to the surgical procedure of performing a bilateral pelvic osteotomy to correct congenital malformations or alignment issues in the pelvis.

3. Procedure

1. During the procedure, the provider makes an incision from the iliac spine to the inguinal area, exposing the pelvic bones.
2. The adductor and iliopsoas muscles are released to provide access to the innominate bone.
3. The provider then performs a bilateral osteotomy of the innominate bone, cutting it with a Gigli saw or similar instrument.
4. The bone is excised 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, using the symphysis as a hinge.
6. This rotation shifts the acetabulum forward and outward, flattening the excessively steep acetabular roof.
7. A separate incision is made to obtain a graft from the iliac bone, which is used to fix the osteotomy site.
8. The provider secures the osteotomy site using screws, plates, or wires.
9. Hemostasis is achieved, and the wound is closed by suturing the soft tissue layers.
10. The patient is then placed in a hip brace for approximately six weeks to aid in the healing process.

4. Qualifying circumstances

CPT code 27158 is used for patients who have congenital malformations or alignment problems in their pelvis that require surgical correction. This procedure is typically performed on young children who have pelvic deformities from birth. The provider must perform a bilateral pelvic osteotomy, meaning the procedure is done on both sides of the pelvis.

5. When to use CPT code 27158

CPT code 27158 should be used when a provider performs a bilateral pelvic osteotomy to correct congenital malformations or alignment issues in the pelvis. It is important to note that this code specifically refers to a bilateral procedure, so if the osteotomy is performed on only one side of the pelvis, a different code should be used.

6. Documentation requirements

To support a claim for CPT code 27158, the provider must document the following information:

• Patient’s diagnosis indicating the need for a bilateral pelvic osteotomy
• Description of the specific malformation or alignment issue being corrected
• Date of the procedure
• Details of the surgical technique used, including any specific instruments or grafts utilized
• Any additional procedures performed in conjunction with the pelvic osteotomy
• Any complications or unexpected findings during the procedure
• Post-operative instructions and follow-up plans

7. Billing guidelines

When billing for CPT code 27158, it is important to ensure that the procedure performed is a bilateral pelvic osteotomy. The provider should also follow any specific billing guidelines provided by the payer or coding guidelines. It is important to accurately document the procedure and any additional services provided during the same encounter.

8. Historical information

CPT code 27158 was added to the Current Procedural Terminology system on January 1, 1990. It has undergone several changes over the years, including being added to the Inpatient Only (IPO) list in 2017 and then removed from the IPO list in 2021. It was subsequently added back to the IPO list in 2022.

9. Examples

1. A pediatric orthopedic surgeon performs a bilateral pelvic osteotomy on a 5-year-old child with a congenital malformation of the pelvis.
2. A patient with a history of hip dysplasia undergoes a bilateral pelvic osteotomy to correct the alignment of the pelvis and stabilize the hip joint.
3. A 3-year-old child with a congenital malformation of the pelvis undergoes a bilateral pelvic osteotomy to improve their mobility and prevent future complications.
4. A bilateral pelvic osteotomy is performed on a 7-year-old child with a congenital malformation of the pelvis to correct the alignment and prevent further hip joint damage.
5. A provider performs a bilateral pelvic osteotomy on a young adult with a congenital malformation of the pelvis to improve their quality of life and alleviate pain.
6. A bilateral pelvic osteotomy is performed on a teenager with a congenital malformation of the pelvis to improve their hip joint stability and prevent future complications.
7. A 6-year-old child with a congenital malformation of the pelvis undergoes a bilateral pelvic osteotomy to correct the alignment and improve their overall function.