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An osteotomy of the femur, specifically targeting the shaft or supracondylar region, is a surgical procedure aimed at correcting bone deformities or realigning the femur. This procedure is essential for addressing various orthopedic conditions that may affect the alignment and function of the leg. The term "osteotomy" refers to the surgical cutting of bone, and in this context, it is performed on the femur, which is the long bone in the thigh. The specific location of the osteotomy, whether at the shaft or the supracondylar area, is determined based on the nature and location of the deformity being treated. Different types of osteotomies can be employed, including transverse, wedge, sliding, right or left angle, V-osteotomy, and Z-osteotomy, each serving a unique purpose depending on the clinical scenario. Prior to the surgical intervention, the physician utilizes radiographic studies to accurately assess the bone structure and determine the optimal site for the osteotomy. This preoperative planning is crucial for achieving the desired surgical outcome. During the procedure, an incision is made over the targeted area of the femur, allowing for the dissection of soft tissues to expose the bone. The periosteum, a dense layer of connective tissue surrounding the bone, is elevated to facilitate access. The surgeon then employs tools such as a drill, saw, or osteotome to create a precise cut in the bone according to the predetermined configuration. In some cases, bone grafts may be inserted between the cut segments to promote healing and stability. To ensure that the bone segments remain properly aligned during the healing process, various fixation methods may be utilized, including pins, screws, or plates. Alternatively, an external fixation device may be applied if deemed necessary. It is important to note that if the procedure is performed without any fixation, a different CPT® code (CPT® 27448) should be used, whereas CPT® 27450 is designated for cases where a fixation device is employed.
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The osteotomy of the femur, specifically the shaft or supracondylar region, is indicated for various orthopedic conditions that necessitate realignment or correction of bone deformities. The following are common indications for this procedure:
The procedure for performing a femoral osteotomy involves several critical steps to ensure successful outcomes. The following outlines the procedural steps:
After the osteotomy procedure, patients typically require a period of recovery and rehabilitation. Post-operative care may include monitoring for complications, managing pain, and ensuring proper wound healing. Patients are often advised to limit weight-bearing activities on the affected leg for a specified duration, which may vary based on the extent of the surgery and the fixation method used. Physical therapy may be initiated to restore mobility and strength in the leg, with a gradual progression to full weight-bearing as healing occurs. Follow-up appointments are essential to assess the healing process and make any necessary adjustments to the rehabilitation plan.
| Short Descr | INCISION OF THIGH | Medium Descr | OSTEOTOMY FEMUR SHAFT/SUPRACONDYLAR W/FIXATION | Long Descr | Osteotomy, femur, shaft or supracondylar; with fixation | 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). | 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.) | 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). | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | 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 | 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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