How To Use CPT Code 27535

CPT 27535 describes the open treatment of a specific type of tibial fracture known as a proximal (plateau) fracture. 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 27535?

CPT 27535 is used to describe the open treatment of a proximal (plateau) fracture of the tibia. This procedure involves the use of internal fixation to ensure proper alignment and stabilization of the fractured bone. It is typically performed by a healthcare provider in a surgical setting.

2. Official Description

The official description of CPT code 27535 is: ‘Open treatment of tibial fracture, proximal (plateau); unicondylar, includes internal fixation, when performed.’

3. Procedure

1. The healthcare provider begins by making an incision on the proximal tibia, either medially or laterally, depending on the location of the fractured condyle.
2. They then reduce the fracture, ensuring correct anatomical alignment, and stabilize it using K wires or other internal fixation devices such as screws and plates.
3. Hemostasis is achieved, and the incision is closed with sutures in layers.

4. Qualifying circumstances

CPT 27535 is used when the provider performs open treatment of a unicondylar proximal tibial plateau fracture, with or without internal or external fixation. This code is specific to fractures of the tibial plateau and should not be used for other types of fractures or procedures.

5. When to use CPT code 27535

CPT code 27535 should be used when a healthcare provider performs open treatment of a unicondylar proximal tibial plateau fracture. 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 27535, the healthcare provider must document the following information:

• Diagnosis of a proximal tibial plateau fracture
• Details of the procedure performed, including the use of internal fixation
• Date of the procedure
• Any additional procedures or services provided during the same encounter
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 27535, it is important to ensure that the procedure meets the specific criteria outlined in the code description. The use of internal fixation should be documented and supported by the medical record. It is also important to follow any additional guidelines or requirements set forth by payers or regulatory bodies.

8. Historical information

CPT 27535 was added to the Current Procedural Terminology system on January 1, 1993. Since then, there have been several changes and updates to the code, including modifications to the code description and its inclusion or exclusion from the Inpatient Only (IPO) list.

9. Examples

1. A surgeon performs open treatment of a unicondylar proximal tibial plateau fracture using internal fixation.
2. A patient sustains a proximal tibial plateau fracture and undergoes open reduction and internal fixation by an orthopedic surgeon.
3. A healthcare provider performs open treatment of a unicondylar proximal tibial plateau fracture with the use of screws and plates for stabilization.
4. An individual fractures their tibial plateau and requires open treatment with internal fixation to ensure proper alignment and healing.
5. A patient undergoes open treatment of a unicondylar proximal tibial plateau fracture following a traumatic injury.
6. A surgeon performs open reduction and internal fixation of a proximal tibial plateau fracture to restore proper alignment and stability.
7. An orthopedic specialist performs open treatment of a unicondylar proximal tibial plateau fracture using K wires for stabilization.
8. A patient with a proximal tibial plateau fracture undergoes open treatment with internal fixation to promote proper healing and prevent complications.
9. A healthcare provider performs open reduction and internal fixation of a unicondylar proximal tibial plateau fracture to restore normal anatomy and function.
10. An individual sustains a proximal tibial plateau fracture and undergoes open treatment with internal fixation to ensure proper alignment and stability.