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An osteotomy of the proximal tibia is a surgical procedure that involves cutting and reshaping the upper part of the tibia, which is the larger bone in the lower leg. This procedure may also include the excision or cutting of a portion of the fibula, the smaller bone located alongside the tibia. The primary purpose of this surgery is to correct deformities of the knee, specifically genu varus, commonly known as bowleg, and genu valgus, referred to as knock-knee. The choice of the specific type of osteotomy performed, such as transverse, wedge, sliding, right or left angle, V-osteotomy, or Z-osteotomy, is determined by the nature and location of the deformity. Prior to the surgery, the physician utilizes radiographic studies to accurately plan the site and configuration of the bone cut to achieve optimal alignment and correction. During the procedure, an incision is made over the lower leg, allowing for dissection of the soft tissues to expose the tibia and fibula. The periosteum, a layer of tissue covering the bone, is elevated to facilitate access. The bone is then cut using specialized instruments, and if necessary, a portion of the fibula is removed or an osteotomy is performed on it as well. Bone grafts may be placed between the cut segments to promote healing and stability. To secure the bones in their new position, various internal fixation devices such as pins, screws, or plates may be used, or alternatively, an external fixation device may be applied. It is important to note that this specific code, CPT® 27457, is utilized when the procedure is performed after the epiphyseal closure, indicating that the patient's bone growth has been completed.
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The osteotomy of the proximal tibia is indicated for the correction of specific knee deformities, particularly:
The procedure begins with the patient being positioned appropriately, followed by the administration of anesthesia. An incision is made over the lower leg to access the tibia and fibula. The soft tissues surrounding these bones are carefully dissected to expose them adequately. Once the bones are visible, the tibial periosteum is elevated to allow for the necessary surgical manipulation. The surgeon then uses a drill, saw, and/or osteotome to create a precise cut in the tibia according to the predetermined configuration based on the deformity. This cut is essential for realigning the bone to correct the deformity. In conjunction with the tibial osteotomy, a portion of the fibula may be excised, or a fibular osteotomy may be performed, following a similar technique. If required, bone grafts are interposed between the cut segments to facilitate healing and ensure stability. After the osteotomy is completed, the surgeon applies internal fixation devices, such as pins, screws, or a plate and screw system, to maintain the anatomical alignment of the bone edges. In some cases, an external fixation device may be utilized instead. The incision is then closed, and the area is dressed appropriately.
After the osteotomy procedure, the patient is typically monitored in a recovery area until the effects of anesthesia wear off. Post-operative care includes managing pain and preventing infection at the surgical site. The patient may be advised to limit weight-bearing activities on the affected leg for a specified period to allow for proper healing. Follow-up appointments are essential to monitor the healing process and assess the alignment of the bones. Physical therapy may be recommended to restore mobility and strength in the leg as recovery progresses. The overall recovery time can vary based on the individual’s health status and adherence to post-operative care instructions.
| Short Descr | REALIGNMENT OF KNEE | Medium Descr | OSTEOT PROX TIBIA FIB EXC/OSTEOT AFTER EPIPHYSL | Long Descr | Osteotomy, proximal tibia, including fibular excision or osteotomy (includes correction of genu varus [bowleg] or genu valgus [knock-knee]); after epiphyseal closure | 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 |
| 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. | LT | Left side (used to identify procedures performed on the left side of the body) | 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). | RT | Right side (used to identify procedures performed on the right side of the body) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | 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). | 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. | 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). | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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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| 2009-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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