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The procedure described by CPT® Code 27724 involves the surgical repair of a nonunion or malunion of the tibia, utilizing an autograft, which is a graft taken from the patient's own body. A nonunion occurs when the fracture fragments fail to heal together after an adequate period, while a malunion refers to a situation where the fragments heal in an incorrect position, leading to potential complications such as bone deformities, joint incongruities, soft tissue issues, and nerve entrapment. The surgical approach begins with exposing the original fracture site in the tibia to assess the condition of the nonunion or malunion. This evaluation is crucial in determining the appropriate repair method. Unlike other procedures that may use internal fixation alone, as seen in CPT® Code 27720, or a sliding bone graft as in CPT® Code 27722, the 27724 code specifically incorporates the use of a bone graft to fill the defect and promote healing. The process includes harvesting a bone autograft, typically from the iliac crest, which involves making an incision over the iliac crest, stripping the muscle to access the bone, and obtaining either cortical or cancellous bone. This harvested bone is then shaped to fit the defect in the tibia, or it may be morcellized and packed into the area needing repair. Internal fixation devices, such as pins or wires, may be employed to secure the graft in place, and additional stabilization is provided using a compression plate and screws. This comprehensive approach aims to restore proper alignment and stability to the tibia, facilitating the healing process and improving the overall function of the limb.
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The procedure coded as CPT® 27724 is indicated for patients who present with a nonunion or malunion of the tibia. The following conditions may warrant this surgical intervention:
The procedure for CPT® 27724 involves several critical steps to ensure effective repair of the tibial nonunion or malunion:
After the completion of the procedure, patients can expect a recovery period that may involve monitoring for signs of healing and potential complications. Post-operative care typically includes pain management, physical therapy to restore function, and follow-up appointments to assess the healing of the bone. The surgical site will need to be kept clean and dry, and any prescribed medications should be taken as directed. The overall goal of the post-procedure care is to ensure that the bone heals properly and that the patient regains full function of the limb.
| Short Descr | REPAIR/GRAFT OF TIBIA | Medium Descr | RPR NON/MAL TIBIA W/ILIAC/OTH AGRFT | Long Descr | Repair of nonunion or malunion, tibia; with iliac or other autograft (includes obtaining graft) | 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) |
This is a primary code that can be used with these additional add-on codes.
| 20703 | Add-on Code MPFS Status: Active Code APC N Removal of drug-delivery device(s), intramedullary (List separately in addition to code for primary procedure) |
| 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). | LT | Left side (used to identify procedures performed on the left side of the body) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | RT | Right side (used to identify procedures performed on the right side of the body) | 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. | 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. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 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). | 99 | Multiple modifiers: under certain circumstances 2 or more modifiers may be necessary to completely delineate a service. in such situations modifier 99 should be added to the basic procedure, and other applicable modifiers may be listed as part of the description of the service. | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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