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A bone graft procedure involves the surgical placement of bone material into specific regions of the femur, particularly the femoral head, neck, intertrochanteric, or subtrochanteric areas. This procedure is essential for addressing various orthopedic conditions where there is a need to fill bone defects, promote the natural process of bone healing known as osteogenesis, and ensure the union of fractured bones. Additionally, bone grafts provide structural stability to the affected area and can be utilized in arthrodesis, which is the surgical fusion of bones. The procedure begins with a lateral skin incision made over the hip joint to access the proximal femur. During the operation, the femoral head may be dislocated from the acetabulum to allow for a thorough inspection of the bone defect. The surgeon assesses the defect to determine the appropriate size and type of bone graft necessary for effective repair. Bone grafts can be harvested from various sites, including the iliac crest, tibia, fibula, and greater trochanter of the femur, and may consist of either cortical or cancellous bone. The harvesting process involves careful dissection and removal of overlying muscle tissue to expose the bone. If cancellous bone is needed, the surgeon will excise the cortical bone layer to access the soft, spongy cancellous bone beneath. Once harvested, the bone graft is prepared for placement, which may involve crushing cancellous bone or reshaping cortical bone to fit the defect precisely. Finally, the graft is placed into the defect, and the incisions at both the harvest site and the femur are meticulously closed in layers to promote optimal healing.
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The bone graft procedure described by CPT® Code 27170 is indicated for various orthopedic conditions that necessitate the repair or stabilization of the femur. The following are specific indications for performing this procedure:
The bone graft procedure involves several critical steps to ensure successful graft placement and healing. The following outlines the procedural steps as described:
Post-procedure care following a bone graft involves monitoring the surgical site for signs of infection and ensuring proper healing of both the graft and the incision sites. Patients may be advised to limit weight-bearing activities on the affected leg for a specified period to allow for adequate healing. Rehabilitation may include physical therapy to restore mobility and strength in the hip joint. Follow-up appointments are essential to assess the integration of the bone graft and the overall recovery process. Additional considerations may include pain management and adherence to prescribed activity restrictions to promote optimal outcomes.
| Short Descr | REPAIR/GRAFT FEMUR HEAD/NECK | Medium Descr | B1 GRF FEM H/N INTERTRCHNTRIC/SUBTRCHNTRIC AREA | Long Descr | Bone graft, femoral head, neck, intertrochanteric or subtrochanteric area (includes obtaining bone graft) | 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. | 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). | 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.) | 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 | 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) | 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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| Pre-1990 | Added | Code added. |
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