How To Use CPT Code 27540

CPT 27540 describes the open treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, including internal fixation, when performed. 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 27540?

CPT 27540 is used to describe the open treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, which includes the use of internal fixation if necessary. This code is used when a provider performs a surgical procedure to ensure correct alignment of the fractured fragments in the knee.

2. Official Description

The official description of CPT code 27540 is: ‘Open treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, includes internal fixation, when performed.’

3. Procedure

1. The provider begins by making an anterior incision at the midline of the knee.
2. They then reduce the fracture by placing the knee straight and inserting K wires.
3. Next, the provider drills holes in the proximal tibia and sutures the two holes together to ensure better movement at the knee.
4. Internal fixation devices, such as pins and screws, are placed at the site of the fracture to gain stabilization.
5. Hemostasis is ensured, and the incision is closed with sutures in layers.
6. Finally, the site is covered with a splint to protect the knee.

4. Qualifying circumstances

CPT 27540 is performed on patients who have intercondylar spine(s) and/or tuberosity fracture(s) of the knee that require open treatment and internal fixation. The procedure is typically performed by a qualified provider who has the necessary expertise in orthopedic surgery. The use of internal fixation is determined based on the specific needs of the patient and the severity of the fracture.

5. When to use CPT code 27540

CPT code 27540 should be used when a provider performs open treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, including internal fixation if necessary. This code is appropriate when the procedure is performed as the primary treatment for the fracture and not as a secondary procedure.

6. Documentation requirements

To support a claim for CPT 27540, the provider must document the following information:

• Patient’s diagnosis of intercondylar spine(s) and/or tuberosity fracture(s) of the knee
• Details of the procedure performed, including the approach, reduction technique, and use of internal fixation
• Date of the procedure
• Any additional procedures or services performed during the same encounter
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 27540, ensure that the procedure meets the criteria for open treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, including the use of internal fixation if performed. It is important to follow the specific guidelines provided by the payer to ensure accurate and appropriate billing. Modifier 57 may be used to indicate that the procedure was the result of a decision for surgery, and modifier 25 may be used to indicate a significant, separately identifiable evaluation and management service performed on the same day as the procedure.

8. Historical information

CPT 27540 was added to the Current Procedural Terminology system on January 1, 1990. Since its addition, there have been several changes and updates to the code, including the addition and removal from the Inpatient Only (IPO) list for Medicare patients.

9. Examples

1. A patient sustains a fracture of the intercondylar spine of the knee and undergoes open treatment with internal fixation using CPT code 27540.
2. A provider performs open treatment of a tuberosity fracture of the knee, including internal fixation, using CPT code 27540.
3. An individual presents with both intercondylar spine and tuberosity fractures of the knee, and the provider performs open treatment with internal fixation using CPT code 27540.
4. A patient undergoes open treatment of an intercondylar spine fracture of the knee, including internal fixation, using CPT code 27540.
5. A provider performs open treatment of a tuberosity fracture of the knee, including internal fixation, using CPT code 27540.
6. An individual sustains a complex fracture involving both the intercondylar spine and tuberosity of the knee, and the provider performs open treatment with internal fixation using CPT code 27540.
7. A patient presents with a displaced intercondylar spine fracture of the knee, and the provider performs open treatment with internal fixation using CPT code 27540.
8. A provider performs open treatment of a comminuted tuberosity fracture of the knee, including internal fixation, using CPT code 27540.
9. An individual sustains a non-displaced intercondylar spine fracture of the knee, and the provider performs open treatment with internal fixation using CPT code 27540.
10. A patient undergoes open treatment of a displaced tuberosity fracture of the knee, including internal fixation, using CPT code 27540.