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The procedure described by CPT® Code 27165 refers to an osteotomy of the proximal femur, specifically targeting the intertrochanteric or subtrochanteric regions. An osteotomy is a surgical operation in which a bone is cut to shorten, lengthen, or change its alignment. This procedure is typically indicated for the correction of congenital or acquired deformities in the hip area, which may affect the patient's mobility and overall quality of life. The surgery begins with a skin incision made over the lateral aspect of the hip joint, allowing access to the underlying soft tissues. These tissues are carefully dissected to expose the proximal femur, which is the upper part of the thigh bone that connects to the hip joint. During the procedure, the femoral head, which is the ball-shaped top of the femur, is dislocated from the acetabulum, the socket of the hip joint. This dislocation is necessary to facilitate the osteotomy, where specific sites on the femur are marked for cutting. A series of precise cuts are made in the trochanteric and/or subtrochanteric regions, creating wedges of bone that can be repositioned to achieve the desired alignment. These wedges are strategically placed at the osteotomy sites to ensure that the angles of the bone are maintained correctly. To secure the bone in its new position, internal fixation devices such as pins, screws, or wires may be utilized. This internal fixation is crucial for stabilizing the bone during the healing process. Once the osteotomy is completed and the bone is secured, the femoral head is replaced back into the acetabulum, and the surgical incisions are closed in layers to promote optimal healing. In some cases, an external fixation system may be applied, either as a primary method or in conjunction with internal fixation, to provide additional support. Finally, a hip spica cast may be applied as needed to immobilize the hip joint and facilitate recovery.
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The osteotomy procedure described by CPT® Code 27165 is indicated for various conditions affecting the intertrochanteric or subtrochanteric regions of the hip. These indications include:
The procedure for an osteotomy of the proximal femur involves several critical steps to ensure successful correction of the deformity. The steps include:
Post-procedure care following an osteotomy of the proximal femur is critical for ensuring proper recovery and minimizing complications. Patients are typically monitored for any signs of infection or complications related to the surgical site. Pain management is an essential aspect of post-operative care, and patients may be prescribed analgesics to manage discomfort. Rehabilitation often begins shortly after surgery, with physical therapy focusing on restoring mobility and strength in the hip joint. The duration of recovery can vary based on the individual patient's condition and the extent of the surgery, but patients are generally advised to avoid weight-bearing activities for a specified period. Follow-up appointments are necessary to assess healing and determine when it is safe to resume normal activities. The application of a hip spica cast, if utilized, will also dictate specific post-operative care instructions to ensure the cast remains intact and the hip joint is properly immobilized during the healing process.
| Short Descr | INCISION/FIXATION OF FEMUR | Medium Descr | OSTEOT INTERTRCHNTRIC/SUBTRCHNTRIC W/INT/XTRNL | Long Descr | Osteotomy, intertrochanteric or subtrochanteric including internal or external fixation and/or cast | 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 | 161 - Other OR therapeutic procedures on bone |
| 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. | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 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). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 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. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 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). | 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 | CR | Catastrophe/disaster related | ET | Emergency services | 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) | RT | Right side (used to identify procedures performed on the right side of the body) | 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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