How To Use CPT Code 27215

CPT 27215 describes the open treatment of iliac spine(s), tuberosity avulsion, or iliac wing fracture(s) on one side of the pelvis bone, without disrupting the pelvic ring. 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 27215?

CPT 27215 is used to describe the open treatment of fractures on one side of the pelvis bone, specifically the iliac spine(s), tuberosity avulsion, or iliac wing fracture(s). This procedure does not involve any disruption of the pelvic ring. The provider may use internal fixation, such as plates or screws, to stabilize the fracture.

2. Official Description

The official description of CPT code 27215 is: ‘Open treatment of iliac spine(s), tuberosity avulsion, or iliac wing fracture(s), unilateral, for pelvic bone fracture patterns that do not disrupt the pelvic ring, includes internal fixation, when performed.’

3. Procedure

1. The provider begins by making an incision over the site of the pelvic injury, after the patient is properly prepped and anesthetized.
2. They then dissect through the subcutaneous tissue, being careful to protect the nerves and vessels.
3. The muscles are retracted to expose the pelvis adequately.
4. The provider realigns or reduces the fracture by adjusting the bone.
5. Internal fixation, such as screws, nails, or plates, is used to secure the reduced fracture bone in place.
6. If there is a fracture of the iliac wing, a plate with screws is placed across the fracture to stabilize the bone fragments.
7. Drains may be placed as necessary.
8. The wound is closed by suturing the skin layers together.
9. An X-ray examination of the pelvis may be performed to confirm the reduction of the fracture.

4. Qualifying circumstances

CPT 27215 is performed on patients with pelvic bone fractures that do not disrupt the pelvic ring. The procedure is indicated for fractures of the iliac spine(s), tuberosity avulsion, or iliac wing on one side of the pelvis. Internal fixation is included in this code when performed. It is important to note that if the procedure is performed bilaterally, modifier 50 should be appended to the code.

5. When to use CPT code 27215

CPT code 27215 should be used when the provider performs an open treatment of iliac spine(s), tuberosity avulsion, or iliac wing fracture(s) on one side of the pelvis bone, without disrupting the pelvic ring. This code should not be used for fractures that involve the pelvic ring.

6. Documentation requirements

To support a claim for CPT 27215, the provider must document the following information:

• Patient’s diagnosis and indication for the procedure
• Details of the procedure performed, including the specific fractures treated
• Use of internal fixation, such as plates or screws
• Date of the procedure
• Any additional procedures or interventions performed
• Signature of the provider

7. Billing guidelines

When billing for CPT 27215, ensure that the procedure meets the criteria specified in the code description. If the procedure is performed bilaterally, modifier 50 should be appended to the code. It is important to follow the specific guidelines provided by the payer to ensure accurate and appropriate reimbursement.

8. Historical information

CPT 27215 was added to the Current Procedural Terminology system on January 1, 1993. The code description was updated on January 1, 2009 to include the mention of internal fixation.

9. Examples

1. A patient sustains a unilateral iliac wing fracture due to a fall. The provider performs an open treatment of the fracture, using internal fixation to stabilize the bone fragments.
2. Following a motor vehicle accident, a patient presents with a tuberosity avulsion fracture on one side of the pelvis. The provider performs an open treatment of the fracture, reducing the bone fragments and using screws for internal fixation.
3. An athlete experiences an injury during a sports event, resulting in a fracture of the iliac spine. The provider performs an open treatment of the fracture, using plates and screws for internal fixation.
4. A patient is involved in a bicycle accident and sustains a unilateral iliac wing fracture. The provider performs an open treatment of the fracture, securing the bone fragments with a plate and screws.
5. Following a fall from a height, a patient presents with multiple fractures, including an avulsion fracture of the iliac tuberosity. The provider performs an open treatment of the fracture, using internal fixation to stabilize the bone fragments.
6. A patient is involved in a motorcycle accident and sustains a unilateral iliac wing fracture. The provider performs an open treatment of the fracture, using screws for internal fixation.
7. An elderly patient falls and fractures the iliac spine on one side of the pelvis. The provider performs an open treatment of the fracture, using plates and screws for internal fixation.