CPT 26991 Hip Bursa I&D Reimbursement | OpenPayer

Summary & Overview

CPT 26991: Incision and Drainage of Infected Hip Bursa

CPT code 26991 denotes incision and drainage of an infected bursa of the pelvis or hip joint — a targeted surgical procedure to evacuate purulent material and control local infection. Nationally, this code is relevant for surgical, emergency, and inpatient billing where prompt source control is required for septic bursitis or joint-associated infections. Proper coding affects reimbursement, quality reporting, and care coordination for musculoskeletal and infectious disease management.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for 26991, typical sites of service where the procedure is performed, and payer coverage considerations. The publication also outlines common billing modifiers and related administrative details when available, and it provides benchmarks and policy context useful for billing professionals, surgical departments, and revenue cycle teams.

This national summary focuses on clinical and billing fundamentals for 26991, helping readers understand where the code applies and what operational areas — such as ambulatory surgery, emergency care, and inpatient services — are most frequently involved. Data not available in the input is noted where applicable.

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Billing Code Overview

CPT code 26991 describes an incision and drainage procedure of an infected bursa of the pelvis or hip joint. The procedure involves making a skin incision over the affected bursa or hip joint to drain pus and relieve an acute purulent infection.

Service type: Surgical incision and drainage of infected bursa/hip joint
Typical site of service: Ambulatory surgical center or hospital operating room, may also be performed in an emergency department setting depending on clinical urgency

Clinical & Coding Specifications

Clinical Context

A 54-year-old man presents to the emergency department with progressive left lateral hip pain, erythema, warmth, and fever. He reports increasing discomfort over three days with difficulty ambulating. Physical exam reveals focal tenderness over the greater trochanter and fluctuance consistent with an abscess within the trochanteric bursa. Laboratory testing shows leukocytosis and elevated inflammatory markers. Ultrasound confirms a fluid collection within the bursal space. The orthopedics team evaluates the patient and recommends an incision and drainage of the infected bursa under local anesthesia in the procedure room or an operating room depending on patient comorbidities and procedural complexity. The workflow includes informed consent, site preparation, local anesthesia or regional block, incision over the bursa, drainage and culture of purulent material, irrigation, and packing or wound closure as indicated. Post-procedure care includes wound dressing, antibiotic therapy guided by culture results, and follow-up for wound checks and possible repeat drainage if necessary. Typical sites of service are the emergency department, ambulatory surgery center, or hospital operating room depending on clinical severity and patient stability. The service type is an operative incision and drainage of an infected bursa of the pelvis or hip, consistent with 26991.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component

CPT 27006: Open Tenotomy of Hip Abductor/Extensor Muscles

CPT-27000-PERCUTANEOUS-ADDUCTOR-TENOTOMY-HIP

CPT 27000: Percutaneous Adductor Tenotomy of Hip

CPT-27036-HIP-CAPSULE-RELEASE-EXCISION-HETEROTOPIC-BONE

CPT 27036: Hip Capsule Release and Excision of Heterotopic Bone

CPT-27003-ADDUCTOR-TENOTOMY-OBTURATOR-NERVE-REMOVAL

CPT 27003: Open Adductor Tenotomy with Obturator Nerve Removal

CPT-27035-HIP-JOINT-NERVE-DENERVATION-FOR-ARTHRITIS-PAIN

CPT 27035: Hip Joint Nerve Denervation for Arthritis Pain

CPT-26990-PELVIS-HIP-DEEP-ABSCESS-DRAINAGE

CPT 26990: Incision and Drainage of Deep Pelvic or Hip Abscess

CPT-27033-OPEN-HIP-JOINT-EXPLORATION-FOREIGN-BODY-REMOVAL

CPT 27033: Open Hip Joint Exploration and Foreign Body Removal

CPT-27005-HIP-FLEXOR-OPEN-TENOTOMY

CPT 27005: Open Tenotomy of Hip Flexor Muscles

CPT-27030-HIP-JOINT-INCISION-EXPLORATION-DRAINAGE-INFECTION

CPT 27030: Hip Joint Incision, Exploration, and Drainage

CPT-27027-HIP-BUTTOCK-FASCIOTOMY-UNILATERAL

CPT 27027: Unilateral Hip/Buttock Compartment Fasciotomy

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Taxonomy Code	Specialty	Notes
207L00000X	Orthopaedic Surgery	Orthopedic surgeons commonly perform surgical drainage of hip/pelvic bursae
208000000X	General Surgery	General surgeons may perform incision and drainage for deep-seated bursal or soft-tissue infections
207RC0000X	Physical Medicine & Rehabilitation	PM&R physicians may perform bedside procedures for superficial bursitis drainage in select settings
363LP0808X	Emergency Medicine	Emergency physicians frequently perform urgent incision and drainage in the ED or coordinate operative care
2084P0800X	Infectious Disease	Infectious disease specialists provide consultation for antimicrobial management though they do not typically perform the procedure

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M71.60`	Bursitis, unspecified, pelvic region and thigh	Direct diagnosis indicating inflammation/infection of a pelvic or hip bursa often requiring incision and drainage
`M71.61`	Trochanteric bursitis	Specifies the greater trochanteric bursa commonly involved in lateral hip infections and abscess formation necessitating `26991`
`M71.62`	Ischial bursitis	Infection of the ischial bursa that can present with localized abscess requiring drainage
`M00.86`	Staphylococcal infection, hip	Represents bacterial septic involvement of hip region structures that may extend to bursae and require drainage and culture
`L03.116`	Cellulitis of right lower limb	Soft-tissue infection adjacent to a bursa that can complicate into an abscess requiring incision and drainage
`L03.115`	Cellulitis of left lower limb	Same clinical relevance on the contralateral side when infection involves tissues near the hip/pelvis bursa
`R65.20`	Severe sepsis without septic shock	Systemic complication from an infected bursa necessitating prompt drainage and systemic management

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`10060`	Incision and drainage of abscess; simple or single	Used for superficial abscesses that may be located adjacent to or above the bursa and managed in a minor procedure setting prior to or instead of `26991`
`10180`	Incision and drainage complicated skin and subcutaneous abscess, major	Used for more complex soft-tissue infections that may extend beyond the bursa and require wide exposure and debridement alongside `26991`
`20610`	Arthrocentesis, aspiration and/or injection; major joint or bursa (e.g., hip, shoulder)	Used for diagnostic aspiration of bursal fluid prior to decision for formal incision and drainage or for therapeutic aspiration when appropriate
`99284`	Emergency department visit, high complexity	Represents typical ED evaluation and management when a patient presents with an acute infected bursa requiring urgent procedural intervention
`99024`	Postoperative follow-up visit (global period)	Used for routine postoperative follow-up care related to the surgical drainage during the global period

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