How To Use CPT Code 27506

CPT 27506 describes the open treatment of a femoral shaft fracture, with or without external fixation, using an intramedullary implant, and may include cerclage and/or locking screws. 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 27506?

CPT 27506 is used to describe the open treatment of a femoral shaft fracture. This procedure involves the provider making an incision at the site of the fracture and manually realigning the bones to their normal position. The provider then inserts an intramedullary implant, such as nails, into the center hollow part of the bone to stabilize the fracture. Cerclage wires may also be used to achieve a better reduction. The main goal of this procedure is to ensure healthy and complete healing of the fractured femoral shaft.

2. Official Description

The official description of CPT code 27506 is: ‘Open treatment of femoral shaft fracture, with or without external fixation, with insertion of intramedullary implant, with or without cerclage and/or locking screws.’

3. Procedure

1. The provider prepares the patient for the procedure, ensuring they are appropriately prepped and anesthetized.
2. An incision is made at the site of the femoral shaft fracture.
3. The provider manually realigns the fractured bones to their normal anatomical position.
4. A hole is drilled through the center of the intramedullary canal.
5. Using fluoroscopy guidance, the provider inserts nails or other intramedullary implants into the canal to stabilize the fracture.
6. Cerclage wires may be threaded around the shaft to achieve a better reduction.
7. If necessary, the provider may fix the implants with screws at the end of the bone for further stability.
8. Traction may be applied to hold the bone in the correct anatomical alignment.

4. Qualifying circumstances

CPT 27506 is performed on patients with a femoral shaft fracture that requires open treatment. This procedure is typically performed by a qualified healthcare professional, such as an orthopedic surgeon. The use of external fixation, cerclage, and/or locking screws may vary depending on the specific circumstances of the fracture and the provider’s judgment.

5. When to use CPT code 27506

CPT code 27506 should be used when the provider performs an open treatment of a femoral shaft fracture. This code is appropriate when the procedure involves the insertion of an intramedullary implant, with or without external fixation, and may include the use of cerclage and/or locking screws. It is important to accurately document the details of the procedure to support the use of this code.

6. Documentation requirements

To support a claim for CPT 27506, the provider must document the following information:

• Patient’s diagnosis of a femoral shaft fracture
• Details of the procedure, including the use of intramedullary implants, external fixation, cerclage, and/or locking screws
• Date of the procedure
• Incision site
• Specific techniques used during the procedure
• Any complications or additional procedures performed
• Signature of the provider

7. Billing guidelines

When billing for CPT 27506, ensure that the procedure meets the criteria described in the official description. The use of external fixation, cerclage, and/or locking screws should be documented and supported by the medical record. It is important to follow the specific guidelines provided by the payer to ensure accurate and appropriate billing for this procedure.

8. Historical information

CPT 27506 was added to the Current Procedural Terminology system on January 1, 1990. There have been several updates and changes to the code over the years, including its inclusion and removal from the Inpatient Only (IPO) list for Medicare. It is important to stay updated on any changes or updates to ensure accurate coding and billing.

9. Examples

1. An orthopedic surgeon performs an open treatment of a femoral shaft fracture using intramedullary nails and cerclage wires.
2. A trauma surgeon performs an open reduction of a complex femoral shaft fracture, using external fixation and intramedullary implants.
3. An orthopedic specialist performs an open treatment of a femoral shaft fracture with locking screws and without external fixation.
4. A pediatric orthopedic surgeon performs an open reduction of a femoral shaft fracture in a child, using intramedullary implants and cerclage wires.
5. A sports medicine physician performs an open treatment of a femoral shaft fracture in an athlete, using intramedullary nails and locking screws.
6. An orthopedic surgeon performs an open reduction of a femoral shaft fracture with intercondylar extension, using intramedullary implants and cerclage wires.
7. A trauma surgeon performs an open treatment of a distal femoral epiphyseal separation, using internal fixation and intramedullary implants.
8. An orthopedic specialist performs an open reduction of a femoral shaft fracture with medial condyle involvement, using intramedullary nails and locking screws.
9. A pediatric orthopedic surgeon performs an open treatment of a femoral shaft fracture with lateral condyle involvement, using intramedullary implants and cerclage wires.
10. A sports medicine physician performs an open reduction of a femoral shaft fracture with intercondylar extension, using intramedullary implants and locking screws.