Summary & Overview
CPT 27506: Open Intramedullary Fixation of Femoral Shaft Fracture
Headline: Open Intramedullary Fixation for Femoral Shaft Fractures: What CPT 27506 Covers
Lead: CPT 27506 denotes open treatment of femoral shaft fractures with insertion of an intramedullary implant, a commonly performed orthopedic surgical procedure for stabilizing diaphyseal femur fractures. This code captures a range of techniques used to secure the femoral shaft, including optional external fixation and adjunctive cerclage or locking screws, and is relevant across inpatient and hospital outpatient surgical settings nationwide.
Why it matters: Accurate use of CPT 27506 affects billing consistency, claims adjudication, and clinical documentation for a high-acuity orthopedic procedure. The code is central to reimbursement and utilization discussions for trauma and orthopedic surgery service lines.
Payers covered: The analysis includes major national payers: Aetna; Blue Cross Blue Shield; Cigna Health; UnitedHealthcare; and Medicare.
What readers will learn: Readers will get a concise overview of the code’s clinical scope and typical sites of service, guidance on common documentation themes tied to the procedure, comparisons to closely related femur fracture procedure codes, and notes on billing nuances such as common modifiers that may affect claim processing. The publication also outlines relevant diagnosis contexts and typical clinical indications tied to femoral shaft fracture management.
Scope limitations: Data not available in the input for payer-specific reimbursement rates or state-specific policy variations.
CPT Code Overview
CPT 27506 describes the open surgical treatment of a femoral shaft fracture that includes insertion of an intramedullary implant. The procedure may be performed with or without external fixation and may include use of cerclage wires and/or locking screws. This code applies to orthopedic surgical management of femoral shaft fractures.
Service type: Orthopedic surgery
Typical site of service: Hospital outpatient or inpatient surgical setting (e.g., POS 22 or POS 21)
Clinical & Coding Specifications
Clinical Context
A 42-year-old male presents to the emergency department after a high-energy motor vehicle collision with severe pain and deformity of the thigh. Imaging confirms a displaced femoral shaft fracture. After initial stabilization, the patient is taken to the operating room in the hospital inpatient surgical setting for open treatment with insertion of an intramedullary implant. Perioperative workflow includes preoperative imaging and planning, administration of regional or general anesthesia, open reduction of the femoral shaft fracture, insertion of an intramedullary nail with locking screws and optional cerclage wires, intraoperative imaging to confirm alignment and fixation, postoperative recovery in the PACU, and inpatient orthopedic follow-up for weight-bearing instructions and discharge planning.
Coding Specifications
-
Modifier
51- Multiple Procedures- Applied when multiple distinct surgical procedures are performed during the same operative session. Use when
27506is one of multiple surgeries billed by the same provider on the same date.
- Applied when multiple distinct surgical procedures are performed during the same operative session. Use when
-
Modifier
59- Distinct Procedural Service- Applied to identify procedures/services that are not normally reported together but are appropriate under the circumstances. Use when an additional procedure during the same operative episode is separate and distinct from
27506.
- Applied to identify procedures/services that are not normally reported together but are appropriate under the circumstances. Use when an additional procedure during the same operative episode is separate and distinct from