How To Use CPT Code 27495

CPT 27495 describes the prophylactic treatment of a defect in the femur using fixation implants such as nails, plates, or screws, with or without the use of methylmethacrylate. 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 27495?

CPT 27495 is used to describe the prophylactic treatment of a defect in the femur using fixation implants, such as nails, plates, or screws. This procedure aims to prevent future issues and may involve the use of methylmethacrylate, a type of bone cement. It is important to note that this code specifically applies to the femur.

2. Official Description

The official description of CPT code 27495 is: ‘Prophylactic treatment (nailing, pinning, plating, or wiring) with or without methylmethacrylate, femur.’

3. Procedure

1. The provider begins by making an incision in the skin above the defect in the femur bone.
2. She then carefully dissects through the subcutaneous tissue and reaches the bone.
3. The provider uses fixation implants, such as nails, plates, or screws, to treat the defect and stabilize the bone.
4. In some cases, she may choose to use methylmethacrylate, a type of bone cement, to provide additional stability by filling the defect.
5. After ensuring hemostasis, or the stoppage of bleeding, at the surgical site, the provider closes the wound by suturing the soft tissue layers.

4. Qualifying circumstances

CPT 27495 is applicable when a patient requires prophylactic treatment for a defect in the femur. The procedure involves the use of fixation implants, such as nails, plates, or screws, with or without the use of methylmethacrylate. It is important to note that this code specifically applies to the femur and not other bones in the body.

5. When to use CPT code 27495

CPT code 27495 should be used when a provider performs prophylactic treatment for a defect in the femur using fixation implants, such as nails, plates, or screws. This code is not appropriate for defects in other bones of the body. It is important to accurately document the use of methylmethacrylate, as this may impact the choice of code.

6. Documentation requirements

To support a claim for CPT 27495, the provider must document the following information:

• Patient’s diagnosis and the need for prophylactic treatment
• Details of the procedure, including the use of fixation implants and methylmethacrylate, if applicable
• Date of the procedure
• Any additional relevant information, such as the size or location of the defect
• Signature of the provider

7. Billing guidelines

When billing for CPT 27495, ensure that the procedure involves the prophylactic treatment of a defect in the femur using fixation implants. It is important to accurately document the use of methylmethacrylate, if applicable. Additionally, be aware of any specific guidelines or requirements from insurance providers or payers.

8. Historical information

CPT 27495 was added to the Current Procedural Terminology system on January 1, 1990. Since then, there have been several historical changes, including updates to the code and its inclusion or exclusion from the Inpatient Only (IPO) list for Medicare patients.

9. Examples

1. A provider performs prophylactic treatment for a defect in the femur using fixation implants and methylmethacrylate.
2. During the procedure, the provider uses nails and plates to stabilize a defect in the femur without the use of methylmethacrylate.
3. A patient undergoes prophylactic treatment for a defect in the femur using screws and methylmethacrylate.
4. The provider performs prophylactic treatment for a defect in the femur using plates and screws, with bone grafting included.
5. During the procedure, the provider uses nails and plates to treat a defect in the femur, with osteotomy performed.
6. A patient requires prophylactic treatment for a defect in the femur using screws and methylmethacrylate, with bone grafting and osteotomy included.
7. The provider performs prophylactic treatment for a defect in the femur using plates and screws, with bone graft substitutes used.
8. During the procedure, the provider uses nails and plates to stabilize a defect in the femur, with bone grafting, osteotomy, and bone graft substitutes included.
9. A patient undergoes prophylactic treatment for a defect in the femur using screws and methylmethacrylate, with bone grafting and bone graft substitutes included.
10. The provider performs prophylactic treatment for a defect in the femur using plates and screws, with osteotomy and bone graft substitutes included.