How To Use CPT Code 27177

CPT 27177 describes the open treatment of slipped femoral epiphysis, which involves the use of pins or bone graft to repair the condition. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 27177?

CPT 27177 is used to describe the open treatment of slipped femoral epiphysis. This procedure involves the use of pins or bone graft to repair the condition. Slipped femoral epiphysis occurs when the femoral head, or epiphysis, slips off the femoral neck due to a fracture of the growth plate, known as the physis. The provider makes an incision, dissects through the soft tissue, and exposes the upper end of the femur to repair the defect or fracture in the growth plate. The procedure may also involve obtaining a bone graft from another part of the body to aid in the repair.

2. Official Description

The official description of CPT code 27177 is: ‘Open treatment of slipped femoral epiphysis; single or multiple pinning or bone graft (includes obtaining graft).’ This code encompasses the use of pins or bone graft to repair the slipped femoral epiphysis, including the process of obtaining the graft if necessary.

3. Procedure

1. The provider begins by making an incision in the skin, extending from the iliac region to the upper end of the thigh.
2. They then dissect through the soft tissue, taking care to protect the nerves and vessels.
3. The muscles are retracted to reach the joint capsule, which is then incised to open the joint and expose the upper end of the femur.
4. If a bone graft is needed, the provider makes a separate incision over the ilium bone and obtains the cancellous bone graft from it.
5. The bone graft is then used to repair the defect or fracture in the growth plate.
6. If pins are used, the provider makes an incision over the intertrochanteric area and inserts multiple pins through the femur head and femur neck under imaging guidance.
7. Hemostasis is achieved at the surgical site, and the wound is closed by suturing the soft tissue in layers.

4. Qualifying circumstances

CPT 27177 is performed on patients with slipped femoral epiphysis, a condition commonly seen in growing children. The procedure is indicated when the femoral head has slipped off the femoral neck due to a fracture of the growth plate. The use of pins or bone graft is necessary to repair the defect or fracture in the growth plate. The procedure is typically performed by a qualified healthcare professional who has the expertise to perform open treatments.

5. When to use CPT code 27177

CPT code 27177 should be used when the provider performs open treatment of slipped femoral epiphysis using single or multiple pinning or bone graft. This code accurately describes the procedure and should be reported for each instance of the treatment. It is important to note that CPT code 27177 should not be reported if the provider performs open treatment of slipped femoral epiphysis by closed manipulation with single or multiple pinning (use CPT code 27178) or with osteoplasty of the femoral neck (use CPT code 27179) or by osteotomy and internal fixation (use CPT code 27181).

6. Documentation requirements

To support a claim for CPT code 27177, the provider must document the following information:

• Patient’s diagnosis of slipped femoral epiphysis
• Details of the procedure performed, including the use of pins or bone graft
• Incision site and length
• Method of obtaining the bone graft, if applicable
• Start and end time of the procedure
• Any complications or additional procedures performed
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 27177, ensure that the procedure meets the criteria for open treatment of slipped femoral epiphysis using single or multiple pinning or bone graft. It is important to accurately document the procedure and any additional services provided. CPT code 27177 should not be reported with other codes that describe different methods of treatment for slipped femoral epiphysis. Additional tips for reporting CPT code 27177 can be found in the official coding guidelines.

8. Historical information

CPT code 27177 was added to the Current Procedural Terminology system on January 1, 1990. It has undergone changes in its status as an inpatient-only procedure, with removal from the inpatient-only list in 2021 and subsequent re-addition in 2022.

9. Examples

1. A surgeon performs open treatment of slipped femoral epiphysis using multiple pins to repair the defect in the growth plate.
2. A pediatric orthopedic specialist performs open treatment of slipped femoral epiphysis using a bone graft obtained from the ilium bone.
3. An orthopedic surgeon performs open treatment of slipped femoral epiphysis using both pins and a bone graft to repair the fracture in the growth plate.
4. A surgeon performs open treatment of slipped femoral epiphysis using a single pin and a bone graft obtained from another part of the body.
5. An orthopedic specialist performs open treatment of slipped femoral epiphysis using multiple pins and a bone graft to repair the defect in the growth plate.
6. A surgeon performs open treatment of slipped femoral epiphysis using a bone graft obtained from the patient’s own body to repair the fracture in the growth plate.