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The CPT® Code 27198 refers to the closed treatment of posterior pelvic ring fractures, dislocations, diastasis, or subluxation involving the ilium, sacroiliac joint, and/or sacrum. This procedure may also encompass associated anterior pelvic ring injuries, which can include fractures or dislocations of the pubic symphysis and/or the superior and inferior pubic rami. The treatment can be performed unilaterally or bilaterally and necessitates manipulation, which requires more than local anesthesia, such as general anesthesia, moderate sedation, or spinal/epidural anesthesia. Closed treatment is essential for aligning and stabilizing the bony structures of the pelvis following an injury, which is often unstable and may involve significant trauma to the surrounding soft tissues and organs. Such injuries typically result from high-energy events, including motor vehicle accidents or falls from heights, and can lead to serious complications due to the proximity of vital pelvic organs, blood vessels, and nerves. The primary objective of this closed treatment is to minimize soft tissue damage, alleviate pain by relieving nerve pressure, and ensure adequate blood circulation. Techniques employed during the procedure may include the use of a pelvic circumferential compression device (PCCD) or a folded sheet to stabilize the pelvis, as well as methods to correct lower extremity positioning to facilitate proper alignment.
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The closed treatment of posterior pelvic ring fractures, dislocations, diastasis, or subluxation is indicated for patients who have sustained injuries to the pelvic region, particularly following high-energy trauma. The following conditions may warrant this procedure:
The closed treatment procedure for posterior pelvic ring injuries involves several critical steps to ensure proper alignment and stabilization of the pelvic structures. The following procedural steps are typically performed:
Following the closed treatment of posterior pelvic ring injuries, patients are typically monitored for any complications and to assess pain levels. Post-procedure care may include pain management strategies, such as analgesics, and instructions for activity restrictions to promote healing. Patients may be advised to avoid weight-bearing activities for a specified period, and follow-up appointments are essential to monitor the healing process and ensure that the pelvic structures remain stable. Rehabilitation may be recommended to restore mobility and strength in the affected areas, and physical therapy may be initiated as part of the recovery plan.
| Short Descr | CLSD TX PELVIC RING FX | Medium Descr | CLSD TX PELVIC RING FX W/MANIPULATION W/ANES | Long Descr | Closed treatment of posterior pelvic ring fracture(s), dislocation(s), diastasis or subluxation of the ilium, sacroiliac joint, and/or sacrum, with or without anterior pelvic ring fracture(s) and/or dislocation(s) of the pubic symphysis and/or superior/inferior rami, unilateral or bilateral; with manipulation, requiring more than local anesthesia (ie, general anesthesia, moderate sedation, spinal/epidural) | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | 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) | 2 - Co-surgeons permitted and no documentation required if the two- specialty requirement is met. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Multiple Reduction Applies | ASC Payment Indicator | Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P3D - Major procedure, orthopedic - other | MUE | 1 |
| 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.) | 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 | GC | This service has been performed in part by a resident under the direction of a teaching physician | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | 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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| 2017-01-01 | Added | Added |
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