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The CPT® Code 27638 refers to the excision or curettage of a bone cyst or benign tumor located in the tibia or fibula, specifically when the procedure involves the use of an allograft. A bone cyst is defined as a fluid-filled space within the bone, which can vary in type and presentation. One of the most common forms is the unicameral or simple bone cyst, recognized as a benign lesion. Another type, the aneurysmal bone cyst, is characterized by vascular tissue that surrounds a blood-filled cystic lesion. Additionally, there are various benign bone tumors, including giant cell tumors, chondromyxoid fibromas, and enchondromas, which may necessitate surgical intervention. During the procedure associated with this code, an incision is made over the lesion site in the tibia or fibula, allowing for the dissection of soft tissues to expose the lesion. If a cystic lesion is identified, the bone is incised to create a window, enabling access to the cyst. The fluid within the cyst is aspirated for laboratory analysis. A curette is then utilized to remove the lining of the cystic cavity completely. In cases where benign tumors are present, the lesion is excised along with a margin of healthy bone. Following the excision or curettage, the defect created in the bone is filled with donor bone, known as an allograft, to promote healing and structural integrity of the bone. This procedure is critical for addressing bone cysts and benign tumors while ensuring proper recovery and function of the affected limb.
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The procedure described by CPT® Code 27638 is indicated for the treatment of specific conditions related to bone cysts and benign tumors in the tibia or fibula. The following are the primary indications for performing this procedure:
The procedure associated with CPT® Code 27638 involves several critical steps to ensure the effective excision or curettage of the bone cyst or benign tumor. The following outlines the procedural steps:
Post-procedure care following the excision or curettage of a bone cyst or benign tumor is essential for optimal recovery. Patients may be monitored for any signs of complications, such as infection or excessive bleeding. Pain management strategies will be implemented to ensure patient comfort. Rehabilitation may be necessary to restore function and strength to the affected limb, and follow-up appointments will be scheduled to assess healing and the success of the procedure. It is important for patients to adhere to any specific post-operative instructions provided by their healthcare provider to facilitate a smooth recovery process.
| Short Descr | REMOVE/GRAFT LEG BONE LESION | Medium Descr | EXC/CURETTAGE CYST/TUMOR TIBIA/FIBULA W/ALGRAFT | Long Descr | Excision or curettage of bone cyst or benign tumor, tibia or fibula; with allograft | 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 | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5B - Ambulatory procedures - musculoskeletal | MUE | 1 | CCS Clinical Classification | 142 - Partial excision 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. | 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.) | 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 | 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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| Pre-1990 | Added | Code added. |
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