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The CPT® Code 27235 refers to the procedure known as percutaneous skeletal fixation of a femoral fracture located at the proximal end, specifically in the neck of the femur. This procedure is typically indicated for patients who have sustained a fracture in this area, which is crucial for maintaining the stability and function of the hip joint. The process begins with obtaining radiographs, which are X-ray images that help confirm the presence of the fracture. A thorough neurovascular examination is conducted to assess the integrity of the nerves and blood vessels surrounding the injury site, ensuring that there are no additional complications that could affect the patient's recovery. Following this assessment, the fracture fragments are manually manipulated back into their proper anatomical alignment, a critical step to ensure optimal healing. After confirming the correct alignment through additional radiographs, the fixation of the fracture is achieved by inserting one or more pins or screws through the skin, which stabilizes the fracture. Typically, three pins or screws are utilized in an inverted triangle configuration to provide adequate support. This minimally invasive approach allows for effective stabilization of the fracture while minimizing damage to surrounding tissues, thereby promoting a quicker recovery for the patient.
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The procedure described by CPT® Code 27235 is indicated for the treatment of specific conditions related to femoral fractures. These include:
The procedure for CPT® Code 27235 involves several critical steps to ensure effective stabilization of the femoral fracture. First, Radiographs are obtained to confirm the presence of the fracture. This imaging is essential for assessing the fracture's characteristics and planning the subsequent steps. Next, a Neurovascular Examination is performed to evaluate the condition of the nerves and blood vessels in the area of the injury, ensuring that there are no complications that could affect the procedure or recovery. Following this assessment, the fracture fragments undergo Manual Reduction, where they are carefully manipulated back into their proper anatomical alignment. This step is crucial for the success of the procedure, as proper alignment is necessary for optimal healing. After confirming the alignment through additional Radiographs, the fixation process begins. Insertion of Pins or Screws is performed, typically using three pins or screws arranged in an inverted triangle configuration for stability. A lateral approach is utilized to drill guide pins into place, traversing the fracture in the neck of the femur. Subsequently, Cannulated Pins or Screws are inserted over the guide pins, crossing the fracture and anchoring into the head of the femur. Once the fixation is secured, the guide pins are removed, and the fixation pins or screws are tightened to apply compression across the fracture site, ensuring stability and promoting healing.
After the completion of the procedure, patients typically undergo a period of monitoring to assess for any immediate complications. Post-procedure care may include pain management, instructions for weight-bearing activities, and rehabilitation exercises to restore mobility and strength. Follow-up appointments are essential to evaluate the healing process through additional radiographs and to ensure that the fixation remains stable. Patients are advised on signs of complications, such as increased pain, swelling, or changes in sensation, which should prompt immediate medical attention. Overall, the expected recovery period will vary based on individual factors, but adherence to post-procedure guidelines is crucial for optimal outcomes.
| Short Descr | TREAT THIGH FRACTURE | Medium Descr | PRQ SKEL FIXJ FEMORAL FX PROX END NECK | Long Descr | Percutaneous skeletal fixation of femoral fracture, proximal end, neck | 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) | 1 - Statutory payment restriction for assistants at surgery applies 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 | Hospital Part B services paid through a comprehensive APC | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P3A - Major procedure, orthopedic - Hip fracture repair | MUE | 1 | CCS Clinical Classification | 146 - Treatment, fracture or dislocation of hip and femur |
| RT | Right side (used to identify procedures performed on the right side of the body) | LT | Left side (used to identify procedures performed on the left side of the body) | GC | This service has been performed in part by a resident under the direction of a teaching physician | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | 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). | 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). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) 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). | 54 | Surgical care only: when 1 physician or other qualified health care professional performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding modifier 54 to the usual procedure number. | 55 | Postoperative management only: when 1 physician or other qualified health care professional performed the postoperative management and another performed the surgical procedure, the postoperative component may be identified by adding modifier 55 to the usual procedure number. | 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. | 99 | Multiple modifiers: under certain circumstances 2 or more modifiers may be necessary to completely delineate a service. in such situations modifier 99 should be added to the basic procedure, and other applicable modifiers may be listed as part of the description of the service. | AG | Primary physician | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | CR | Catastrophe/disaster related | ET | Emergency services | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | 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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| 2024-01-01 | Changed | Guideline added. |
| 2003-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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