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The procedure described by CPT® Code 27540 pertains to the open treatment of fractures located at the intercondylar spine(s) and/or tuberosity of the knee. The intercondylar spine, also known as the intercondylar eminence or tibial spine, is characterized by two upward projections situated centrally on the proximal surface of the tibia, positioned between the lateral and medial condyles. This anatomical feature plays a crucial role in the stability of the knee joint. The tibial tuberosity, on the other hand, is a prominent projection found on the anterior aspect of the proximal tibia, serving as the attachment point for the patellar ligament, which is essential for knee extension. In cases of intercondylar tibial spine fractures, the surgical approach involves making an incision over the anterior medial aspect of the knee. This allows for access to the medial joint capsule, which is then incised to evacuate any hematoma present. The fracture site is meticulously exposed, cleared of any debris, and subsequently reduced to restore proper alignment. To secure the fracture fragments, various internal fixation methods may be employed, including the use of sutures, wires, screws, or pins. Following the reduction, anatomical alignment is confirmed through radiographic imaging. For tibial tuberosity fractures, the surgical procedure begins with an incision over the anterior medial knee, directly above the proximal tibia. Similar to the intercondylar spine procedure, the fracture site is exposed and cleared of debris before reduction. Fractures that do not involve the articular surface are typically stabilized using one or two screws that are inserted through the tibial tubercle into the proximal tibia. In contrast, fractures that do involve the articular surface necessitate an anterior medial arthrotomy to allow for proper access and treatment. After reducing the fracture, temporary wire fixation is applied, and alignment is again verified radiographically before the application of permanent screw fixation to ensure stability and proper healing.
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The open treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, as described by CPT® Code 27540, is indicated for specific conditions and symptoms that necessitate surgical intervention. These indications include:
The procedure for the open treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee involves several critical steps, which are detailed as follows:
Post-procedure care following the open treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee involves monitoring for complications and ensuring proper recovery. Patients are typically advised to follow a rehabilitation program that may include physical therapy to restore range of motion and strength in the knee. Pain management strategies are also implemented to address discomfort during the recovery phase. Regular follow-up appointments are necessary to assess healing through radiographic imaging and to make any adjustments to the treatment plan as needed. It is essential to monitor for signs of infection or complications related to the surgical site, ensuring that the patient adheres to post-operative instructions for optimal recovery.
| Short Descr | TREAT KNEE FRACTURE | Medium Descr | OPEN TX INTERCONDYLAR SPINE/TUBRST FRACTURE KNEE | Long Descr | Open treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, includes internal fixation, when performed | 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 | 147 - Treatment, fracture or dislocation of lower extremity (other than hip or femur) |
| 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.) | 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 | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | 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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| 2008-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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