How To Use CPT Code 27536

CPT 27536 describes the open treatment of a bicondylar proximal tibial fracture, with or without internal fixation. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 27536?

CPT 27536 involves the open treatment of a bicondylar proximal tibial fracture. The procedure aims to ensure the correct alignment of the fractured fragments. It may include the use of internal fixation devices such as screws and plates to stabilize the fracture. This code is used when the provider performs the procedure on both the medial and lateral condyles of the tibial plateau.

2. Official Description

The official description of CPT code 27536 is: ‘Open treatment of tibial fracture, proximal (plateau); bicondylar, with or without internal fixation.’ This code should be used for the open reduction and internal fixation of a bicondylar proximal tibial fracture.

3. Procedure

1. The provider makes a midline incision on the proximal tibia to access both the medial and lateral compartments of the tibia.
2. The fractured fragments are reduced and held in place using a K wire to ensure correct anatomical alignment and stabilization.
3. Additional internal fixation devices, such as screws and plates, may be used at the distal end of the fracture to prevent bone collapse.
4. Hemostasis is ensured, and the incision is closed with sutures in layers.

4. Qualifying circumstances

CPT 27536 is performed on patients with a bicondylar proximal tibial fracture that requires open treatment. The procedure is typically performed by a provider who is experienced in fracture treatment and has the necessary qualifications. The use of internal fixation devices may be necessary to stabilize the fracture and prevent bone collapse.

5. When to use CPT code 27536

CPT code 27536 should be used when the provider performs open treatment of a bicondylar proximal tibial fracture. It is important to note that this code is specifically for open treatment and should not be used for arthroscopic treatment of the fracture. If the provider performs both closed and open reduction to treat the fracture, separate codes should be used.

6. Documentation requirements

To support a claim for CPT 27536, the provider must document the following information:

• Diagnosis of a bicondylar proximal tibial fracture
• Description of the procedure performed, including the use of internal fixation devices
• Date of the procedure
• Details of the incision and closure
• Any additional procedures or services provided
• Signature of the provider

7. Billing guidelines

When billing for CPT 27536, ensure that the procedure meets the criteria for open treatment of a bicondylar proximal tibial fracture. It is important to use the appropriate code based on the specific procedure performed. If the provider performs both closed and open reduction, separate codes should be used. Additionally, consider any additional supplies or services provided during the procedure and report them accordingly.

8. Historical information

CPT 27536 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 patients.

9. Examples

1. A provider performs open treatment of a bicondylar proximal tibial fracture using internal fixation devices to stabilize the fracture.
2. A patient sustains a bicondylar proximal tibial fracture in a car accident and undergoes open treatment with the use of screws and plates.
3. A provider performs open reduction and internal fixation of a bicondylar proximal tibial fracture caused by a sports injury.
4. A patient with a bicondylar proximal tibial fracture undergoes open treatment to ensure correct alignment and stabilization of the fractured fragments.
5. A provider performs open treatment of a bicondylar proximal tibial fracture using a combination of K wires and screws for fixation.
6. A patient presents with a bicondylar proximal tibial fracture and undergoes open treatment with the use of plates and screws for stabilization.
7. A provider performs open reduction and internal fixation of a bicondylar proximal tibial fracture caused by a fall.
8. A patient sustains a bicondylar proximal tibial fracture in a workplace accident and undergoes open treatment with the use of internal fixation devices.
9. A provider performs open treatment of a bicondylar proximal tibial fracture using screws and plates to stabilize the fracture.
10. A patient with a bicondylar proximal tibial fracture undergoes open reduction and internal fixation to ensure proper alignment and stability of the fractured fragments.