How To Use CPT Code 27538

CPT 27538 describes the closed treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, with or without manipulation. 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 27538?

CPT 27538 is used to describe the closed treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, with or without manipulation. This code is used when the provider performs a closed reduction of the fracture, aiming to maintain the fractured fragments in the correct position for normal healing.

2. Official Description

The official description of CPT code 27538 is: ‘Closed treatment of intercondylar spine(s) and/or tuberosity fracture(s) of knee, with or without manipulation. (For arthroscopic treatment, see 29850, 29851)’

3. Procedure

1. The provider begins by prepping and anesthetizing the patient.
2. Radiographic images are obtained to determine if the fracture is displaced or nondisplaced.
3. If the fracture is displaced, the provider performs a closed reduction through manual manipulation.
4. A long knee cast or splint is then applied for four to six weeks to immobilize the knee.
5. If the fracture is nondisplaced, no manipulation is performed, and a long leg cast is applied to immobilize the knee.

4. Qualifying circumstances

CPT 27538 is used for patients with intercondylar spine(s) and/or tuberosity fracture(s) of the knee that require closed treatment. The provider must determine if the fracture is displaced or nondisplaced through radiographic images. Displaced fractures are reduced through manual manipulation, while nondisplaced fractures do not require manipulation. The goal is to maintain the fractured fragments in the correct position for normal healing.

5. When to use CPT code 27538

CPT code 27538 should be used when the provider performs closed treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, with or without manipulation. This code is not appropriate for arthroscopic treatment, which has its own specific codes (29850, 29851).

6. Documentation requirements

To support a claim for CPT 27538, the provider must document the following information:

• Whether the fracture is displaced or nondisplaced
• Details of any closed reduction performed
• Type of immobilization applied (long knee cast or splint for displaced fractures, long leg cast for nondisplaced fractures)

7. Billing guidelines

When billing for CPT 27538, ensure that the procedure performed is closed treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, with or without manipulation. This code should not be reported for arthroscopic treatment. Additional supplies of casting materials may be reported separately using the appropriate HCPCS codes.

8. Historical information

CPT 27538 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A patient presents with a displaced intercondylar spine fracture of the knee. The provider performs closed reduction and applies a long knee cast for immobilization.
2. A patient has a nondisplaced tuberosity fracture of the knee. The provider applies a long leg cast for immobilization.
3. A patient sustains a displaced intercondylar spine and tuberosity fracture of the knee. The provider performs closed reduction and applies a long knee splint for immobilization.
4. A patient has a nondisplaced intercondylar spine fracture of the knee. The provider applies a long leg cast for immobilization.
5. A patient presents with a displaced tuberosity fracture of the knee. The provider performs closed reduction and applies a long knee cast for immobilization.
6. A patient has a nondisplaced intercondylar spine and tuberosity fracture of the knee. The provider applies a long leg cast for immobilization.
7. A patient sustains a displaced intercondylar spine fracture of the knee. The provider performs closed reduction and applies a long knee splint for immobilization.
8. A patient has a nondisplaced tuberosity fracture of the knee. The provider applies a long leg cast for immobilization.
9. A patient presents with a displaced intercondylar spine and tuberosity fracture of the knee. The provider performs closed reduction and applies a long knee cast for immobilization.
10. A patient has a nondisplaced intercondylar spine fracture of the knee. The provider applies a long leg cast for immobilization.