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Osteotomy, multiple, with realignment on intramedullary rod, femoral shaft (CPT® Code 27454) refers to a surgical procedure that involves making multiple cuts in the femur, which is the long bone in the thigh, to correct deformities or to realign the bone structure. This procedure is particularly relevant in cases where the femur has developed a deformity that affects its function or alignment. The specific type and location of the osteotomies performed are tailored to the individual patient's needs, depending on the nature and site of the deformity. Various techniques may be employed, including transverse, wedge, sliding, right or left angle, V-osteotomy, and Z-osteotomy, each chosen based on the specific anatomical and pathological considerations. Prior to the surgical intervention, the physician utilizes radiographic studies to precisely determine the locations for the bone cuts, ensuring that the surgical approach is well-planned. The procedure typically begins with a longitudinal incision over the femoral shaft, followed by careful dissection of the soft tissues to expose the femur. The periosteum, a dense layer of connective tissue surrounding the bone, is elevated to allow access to the bone itself. The surgeon then employs tools such as drills, saws, and osteotomes to create the necessary bone cuts in the predetermined configuration. After the osteotomies are made, an appropriately sized intramedullary rod is selected to provide internal stabilization. This rod is inserted into the intramedullary canal of the femur, which is drilled or reamed to accommodate the rod. If a cannulated rod is utilized, a guidewire is first placed into the canal to facilitate the rod's placement. Once the rod is positioned correctly, the bone is realigned at each osteotomy site, and the rod is secured in place using screws, pins, or other fixation devices, ensuring stability and proper healing of the femur.
© Copyright 2025 Coding Ahead. All rights reserved.
Multiple osteotomies of the femoral shaft with realignment on an intramedullary rod are indicated for various conditions that necessitate correction of deformities or realignment of the femur. The following are specific indications for this procedure:
The procedure for multiple osteotomies with realignment on an intramedullary rod involves several critical steps, each designed to ensure the successful correction of the femoral deformity:
Post-procedure care following multiple osteotomies with intramedullary rod placement involves monitoring the patient for any complications and ensuring proper recovery. Patients are typically advised to follow a rehabilitation program that may include physical therapy to restore mobility and strength in the affected limb. Pain management strategies are implemented to address postoperative discomfort. The surgical site is monitored for signs of infection or improper healing, and follow-up appointments are scheduled to assess the alignment and stability of the femur as it heals. Weight-bearing activities may be restricted initially, with gradual progression based on the surgeon's recommendations and the patient's recovery progress.
| Short Descr | REALIGNMENT OF THIGH BONE | Medium Descr | OSTEOT MLT W/RELIGNMT IMED ROD FEM SHFT | Long Descr | Osteotomy, multiple, with realignment on intramedullary rod, femoral shaft (eg, Sofield type procedure) | 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 |
| 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). | 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 | 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) |
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| Pre-1990 | Added | Code added. |
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