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An osteotomy of the iliac, acetabular, or innominate bone, as described by CPT® Code 27147, is a surgical procedure aimed at correcting congenital malformations of these bones that can lead to hip subluxation or dislocation. This procedure is essential for restoring proper alignment and function of the hip joint. The term 'osteotomy' refers to the surgical cutting of bone, which allows for the reshaping and repositioning of the affected bone structures. In this case, the iliac, acetabular, or innominate bones are specifically targeted to address the underlying issues causing hip instability. The procedure involves careful preoperative evaluation to determine the exact nature of the malformation, followed by the exposure of the bone that requires reshaping. The surgeon marks the planned osteotomy site and makes precise cuts in the bone, enabling the reconfiguration of its shape. If the femoral head is found to be malpositioned, it may be reduced to its proper position before the osteotomy is performed around it. This technique ensures that the reshaped bones can properly conform to the femoral head's size and shape. Additionally, wedges created from the cut bone are strategically placed at the osteotomy sites to maintain the correct angles, and internal fixation devices such as pins, screws, or wires may be utilized to secure the bone in its new position. It is important to note that CPT® Code 27147 should be used when the procedure includes both the osteotomy and the open reduction of the hip, while CPT® Code 27146 is designated for cases involving osteotomy only.
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The osteotomy of the iliac, acetabular, or innominate bone is indicated for specific conditions that affect the hip joint. These indications include:
The procedure for performing an osteotomy of the iliac, acetabular, or innominate bone with open reduction of the hip involves several critical steps:
After the osteotomy and open reduction of the hip, the patient will require careful monitoring and post-operative care. This includes pain management, wound care, and rehabilitation to restore mobility and strength. The expected recovery period may vary depending on the individual patient's condition and the extent of the surgery. Follow-up appointments are essential to assess healing and ensure that the hip joint is functioning properly. Physical therapy may be recommended to aid in the recovery process and to help the patient regain full range of motion and strength in the hip joint.
| Short Descr | REVISION OF HIP BONE | Medium Descr | OSTEOTOMY ILIAC ACETABULAR/INNOMINATE HIP RDCTJ | Long Descr | Osteotomy, iliac, acetabular or innominate bone; with open reduction of hip | 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) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | 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 | 1 | CCS Clinical Classification | 162 - Other OR therapeutic procedures on joints |
| 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). | 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.) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) |
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| Pre-1990 | Added | Code added. |
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