How To Use CPT Code 27556

CPT 27556 describes the open treatment of knee dislocation, which includes internal fixation if performed, without primary ligamentous repair or augmentation/reconstruction. 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 27556?

CPT 27556 can be used to describe the open treatment of knee dislocation, which involves the correction of a dislocated knee through an open reduction and internal fixation procedure. However, this code does not include primary ligamentous repair or augmentation/reconstruction.

2. Official Description

The official description of CPT code 27556 is: ‘Open treatment of knee dislocation, includes internal fixation, when performed; without primary ligamentous repair or augmentation/reconstruction.’

3. Procedure

1. During the procedure, the healthcare provider makes an anterior midline incision after the patient is appropriately prepped and anesthetized.
2. The loose fragments around the dislocated knee are debrided, and the provider manually manipulates the knee to return it to the correct anatomical position.
3. An internal fixation device, such as a pin or screw, is used to maintain the stability of the knee and prevent future dislocations.
4. Hemostasis is ensured, and the incision is closed with sutures in layers.

4. Qualifying circumstances

CPT 27556 is used for patients who require open treatment of knee dislocation without primary ligamentous repair or augmentation/reconstruction. This code is applicable when the healthcare provider performs an open reduction and internal fixation procedure for a dislocated knee, but does not repair or reconstruct the primary ligaments.

5. When to use CPT code 27556

CPT code 27556 should be used when the healthcare provider performs an open treatment of knee dislocation, including internal fixation if performed, without primary ligamentous repair or augmentation/reconstruction. 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 27556, the healthcare provider must document the following information:

• Details of the open treatment procedure performed
• Confirmation that primary ligamentous repair or augmentation/reconstruction was not performed
• Date of the procedure
• Any additional relevant information or findings
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 27556, ensure that the procedure meets the specific criteria outlined in the code description. It is important to accurately report the services provided and not include primary ligamentous repair or augmentation/reconstruction in the billing. Review any additional guidelines or requirements from the payer to ensure proper reimbursement.

8. Historical information

CPT 27556 was added to the Current Procedural Terminology system on January 1, 1990. There have been several historical changes to the code, including updates to the code description and its inclusion or exclusion from the Inpatient Only (IPO) list for Medicare reimbursement.

9. Examples

1. A healthcare provider performs an open treatment of knee dislocation, including internal fixation, without primary ligamentous repair or augmentation/reconstruction.
2. During the procedure, the provider corrects the dislocated knee through an open reduction and uses internal fixation to stabilize the knee.
3. The healthcare provider documents the details of the procedure, including the absence of primary ligamentous repair or augmentation/reconstruction.
4. Another healthcare provider performs an open treatment of knee dislocation, including internal fixation, without primary ligamentous repair or augmentation/reconstruction.
5. The procedure is performed to correct the dislocated knee and ensure stability using internal fixation.
6. The healthcare provider accurately documents the procedure and confirms the absence of primary ligamentous repair or augmentation/reconstruction.
7. A patient undergoes an open treatment of knee dislocation, including internal fixation, without primary ligamentous repair or augmentation/reconstruction.
8. The procedure is performed to address the dislocated knee and provide stability through internal fixation.
9. The healthcare provider includes all necessary documentation, clearly indicating the absence of primary ligamentous repair or augmentation/reconstruction.
10. Another patient receives an open treatment of knee dislocation, including internal fixation, without primary ligamentous repair or augmentation/reconstruction.