How To Use CPT Code 27259

CPT 27259 describes the open treatment of spontaneous hip dislocation, including congenital or pathological cases, involving the replacement of the femoral head in the acetabulum. 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 27259?

CPT 27259 is used to describe the open treatment of spontaneous hip dislocation, which can be present from birth or result from a disease. The procedure involves repositioning the head of the thigh bone and shortening its shaft through an incision in the hip.

2. Official Description

The official description of CPT code 27259 is: ‘Open treatment of spontaneous hip dislocation (developmental, including congenital or pathological), replacement of femoral head in acetabulum (including tenotomy, etc); with femoral shaft shortening.’

3. Procedure

1. The provider makes an incision along the iliac crest, at the top of the pelvic bone, to access the hip joint.
2. The provider separates the abductor muscles from the ilium and the rectus femoris and sartorius muscles from the pelvis.
3. A second incision is made in the joint capsule to widen the acetabulum by clearing away the ligamentum teres and the fat.
4. The provider then reduces the hip joint to align it into the correct anatomical position.
5. The provider shortens the shaft of the femur.
6. A plate and screws are inserted in the femoral neck to secure the reduction.
7. The area is irrigated, checked for bleeding, instruments are removed, and the incision is closed.

4. Qualifying circumstances

CPT 27259 is performed on patients with spontaneous hip dislocation, which can be congenital or pathological in nature. The procedure involves the replacement of the femoral head in the acetabulum and may include tenotomy and femoral shaft shortening.

5. When to use CPT code 27259

CPT code 27259 should be used when performing the open treatment of spontaneous hip dislocation, including congenital or pathological cases, with the replacement of the femoral head in the acetabulum. It is important to ensure that the procedure meets the specific criteria outlined in the code description.

6. Documentation requirements

To support a claim for CPT 27259, the provider must document the following information:

• Patient’s diagnosis of spontaneous hip dislocation
• Details of the procedure performed, including the incision, repositioning of the femoral head, and femoral shaft shortening
• Any additional procedures performed, such as tenotomy
• Any complications or unexpected findings during the procedure
• Post-operative care instructions
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 27259, ensure that the procedure meets the specific criteria outlined in the code description. Append the appropriate modifiers, such as modifier 50 for bilateral procedures or modifiers RT/LT for procedures performed on one side of the hip joint. It is important to follow payer guidelines and provide any additional documentation or information as required.

8. Historical information

CPT 27259 was added to the Current Procedural Terminology system on January 1, 1990. It was initially removed from the Inpatient Only (IPO) list in 2017 but was later added back to the list in 2022.

9. Examples

1. A patient with congenital hip dislocation undergoes open treatment with the replacement of the femoral head in the acetabulum and femoral shaft shortening.
2. A patient with a pathological hip dislocation requires open treatment with the replacement of the femoral head in the acetabulum and femoral shaft shortening.
3. A provider performs open treatment for a patient with a congenital hip dislocation, including tenotomy and femoral shaft shortening.
4. A patient with a pathological hip dislocation undergoes open treatment with the replacement of the femoral head in the acetabulum, without femoral shaft shortening.
5. A provider performs open treatment for a patient with a congenital hip dislocation, including tenotomy and without femoral shaft shortening.
6. A patient with a pathological hip dislocation requires open treatment with the replacement of the femoral head in the acetabulum, with femoral shaft shortening.
7. A provider performs open treatment for a patient with a congenital hip dislocation, without tenotomy and with femoral shaft shortening.
8. A patient with a pathological hip dislocation undergoes open treatment with the replacement of the femoral head in the acetabulum, with tenotomy and femoral shaft shortening.
9. A provider performs open treatment for a patient with a congenital hip dislocation, without tenotomy and without femoral shaft shortening.
10. A patient with a pathological hip dislocation requires open treatment with the replacement of the femoral head in the acetabulum, with tenotomy and without femoral shaft shortening.