2025 CPT code 27226
(Active) Effective Date: N/A Revision Date: N/A Surgery - Musculoskeletal System Feed
Open treatment of posterior or anterior acetabular wall fracture, with internal fixation.
Modifiers may be applicable to 27226. For instance, modifier 54 (Surgical Care Only) may be used if the surgeon only performs the surgical portion of the procedure, while modifier 76 (Repeat Procedure by Same Physician) would indicate a re-reduction of the fracture.
Medical necessity must be established for CPT 27226.The documentation should clearly demonstrate the need for surgical intervention due to instability or displacement of the acetabular fracture that cannot be managed conservatively.
The physician is responsible for the entire surgical process, from pre-operative planning and obtaining informed consent, to performing the procedure, post-operative care, and managing any potential complications.This includes accurate documentation of the procedure and coding for reimbursement.
In simple words: This surgery fixes a broken hip socket. The surgeon makes a cut to reach the broken bone, puts the pieces back together, and then uses metal plates and screws to hold it in place while it heals.
This procedure involves open treatment of a fracture of the posterior or anterior acetabular wall, utilizing internal fixation methods like plates, screws, pins, or nails.The surgeon makes an incision to expose the fracture, reduces the fracture fragments, and then stabilizes the fracture using the chosen internal fixation devices.
Example 1: A 25-year-old male sustains a posterior acetabular wall fracture in a motor vehicle accident.An open reduction and internal fixation using plates and screws (CPT 27226) is performed., A 70-year-old female falls and sustains an anterior acetabular wall fracture.She undergoes open treatment with internal fixation using screws (CPT 27226)., A 40-year-old male is involved in a bicycle accident and suffers a complex acetabular fracture involving both the anterior and posterior walls.While code 27226 covers single wall fractures, for this more extensive injury another code such as 27228 would be more appropriate.
Documentation should include details of the fracture (location, type), the surgical approach used, the type of internal fixation devices utilized, any complications encountered, and post-operative instructions. Operative reports, imaging studies (X-rays, CT scans), and progress notes are essential.
- RVU: Varies by location and payer
- Global Days: Global days vary by payer policies.
- Payment Status: Active
- Modifier TC rule: Modifier TC (Technical Component) does not generally apply to 27226, as the surgeon performs both the technical and professional components of the procedure.
- Fee Schedule: Historical fee data can vary based on locality and payer. Consult historical fee schedules for specific information.
- Specialties:Orthopedic Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center