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Official Description

Incision, bone cortex, pelvis and/or hip joint (eg, osteomyelitis or bone abscess)

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 26992 involves making an incision in the bone cortex of the pelvis and/or hip joint, specifically targeting conditions such as osteomyelitis or a bone abscess. The bone cortex is the outer layer of the bone, and in this case, it pertains to bones in the pelvic region or the hip joint, which includes critical structures like the head or neck of the femur. The surgical process begins with an incision through the skin and soft tissue that covers the infected area of the bone. This incision allows access to the periosteum, which is the dense layer of vascular connective tissue enveloping the bones, and is elevated to expose the underlying bone. A small section, referred to as a button of cortical bone, is then removed to access the bone marrow beneath. This step is crucial as it alleviates pressure that may have built up due to inflammation in the bone marrow, thereby restoring blood flow to the affected area. If pus is present, indicating an infection, the initial incision may be enlarged using specialized instruments such as a chisel or gouge, allowing for further drainage and treatment of the abscess. In cases where the epiphysis, the end part of a long bone, is also affected, a portion of the epiphyseal cortex may be excised to ensure complete drainage and treatment of the infection.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The procedure associated with CPT® Code 26992 is indicated for specific conditions affecting the bone cortex of the pelvis and/or hip joint. These indications include:

  • Osteomyelitis - A severe bone infection that can lead to the destruction of bone tissue and requires surgical intervention to remove infected material.
  • Bone Abscess - A localized collection of pus within the bone, often resulting from infection, which necessitates drainage to alleviate pain and prevent further complications.

2. Procedure

The procedure for CPT® Code 26992 involves several critical steps to effectively treat the underlying condition. The steps are as follows:

  • Step 1: Incision - The surgical process begins with making an incision through the skin and soft tissue over the site of the infected bone. This initial incision is essential for gaining access to the underlying structures.
  • Step 2: Elevation of the Periosteum - Once the incision is made, the periosteum, which is the connective tissue layer surrounding the bone, is carefully elevated. This step is crucial as it protects the bone while allowing access to the cortical bone beneath.
  • Step 3: Removal of Cortical Bone - A button of cortical bone is then removed to expose the underlying bone marrow. This action is necessary to relieve pressure caused by inflammation and to facilitate proper drainage of any infected material.
  • Step 4: Drainage of Abscess - If pus is encountered during the procedure, the initial button hole may be enlarged using a chisel or gouge. This extension allows for effective drainage of the abscess, which is vital for treating the infection.
  • Step 5: Removal of Epiphyseal Cortex (if necessary) - In cases where the epiphysis is involved, a section of the epiphyseal cortex may be excised to ensure complete drainage and treatment of the infection.

3. Post-Procedure

After the completion of the procedure, appropriate post-operative care is essential for recovery. Patients may require monitoring for signs of infection or complications. Pain management strategies will be implemented, and the surgical site will need to be kept clean and dry to promote healing. Follow-up appointments will be necessary to assess the healing process and ensure that the infection has been adequately addressed. Rehabilitation may also be recommended to restore function and mobility in the affected area.

Short Descr DRAINAGE OF BONE LESION
Medium Descr INCISION BONE CORTEX PELVIS&/HIP JOINT
Long Descr Incision, bone cortex, pelvis and/or hip joint (eg, osteomyelitis or bone abscess)
Status Code Active Code
Global Days 090 - Major Surgery
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 0 - Co-surgeons not permitted for this procedure.
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Inpatient Procedures, not paid under OPPS
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P3D - Major procedure, orthopedic - other
MUE 2
CCS Clinical Classification 161 - Other OR therapeutic procedures on bone

This is a primary code that can be used with these additional add-on codes.

20700 Add-on Code MPFS Status: Active Code APC N ASC N1 Manual preparation and insertion of drug-delivery device(s), deep (eg, subfascial) (List separately in addition to code for primary procedure)
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
RT Right side (used to identify procedures performed on the right side of the body)
22 Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service.
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
81 Minimum assistant surgeon: minimum surgical assistant services are identified by adding modifier 81 to the usual procedure number.
82 Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s).
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
GC This service has been performed in part by a resident under the direction of a teaching physician
LT Left side (used to identify procedures performed on the left side of the body)
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
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