CPT 26992 Pelvic/Hip Bone Cortex Incision Reimbursement | OpenPayer

Summary & Overview

CPT 26992: Incision of Pelvic or Hip Bone Cortex for Infection

CPT code 26992 denotes an operative procedure that incises the cortical surface of a pelvic or hip bone to manage infection. This procedure is clinically significant because surgical access to the bone cortex can be essential for treating osteomyelitis or other deep-seated osseous infections in the pelvis or hip, conditions that can carry substantial morbidity and resource use. Nationally, accurate coding for this procedure affects clinical reporting, utilization tracking, and payer adjudication.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find concise benchmarking and coverage context relevant to these major payers, an outline of the clinical setting and service characteristics, and notes on coding considerations that influence claim processing. The publication summarizes typical sites of service, service line placement, and common clinical scenarios tied to the procedure. It also highlights where data are available versus where input was not provided.

This summary is intended for clinicians, billers, and policy analysts seeking a compact, national-level reference on CPT code 26992, its clinical role, and implications for billing and payer interactions.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare26992CPTpelvishipbone cortex incisionsurgical debridementosteomyelitisoperating roomprocedural coding

Billing Code Overview

CPT code 26992 describes a surgical procedure in which the provider incises the bone cortex, the superficial layer of bone, to treat an infection in a bone of the pelvis and/or hip joint. The procedure addresses osseous infection by creating an opening in the cortical bone to allow drainage, debridement, or access for further management.

Service type: Surgical debridement/incision of bone cortex for infection
Typical site of service: Inpatient or outpatient operating room or surgical suite for pelvis and hip region

Clinical & Coding Specifications

Clinical Context

A 58-year-old male with a history of diabetes and chronic corticosteroid use presents with worsening right hip pain, fever, and limited weight bearing. Imaging (plain radiographs and MRI) demonstrates osteomyelitis of the periarticular pelvis/hip region with subcortical bone involvement and a small cortical sequestrum. The orthopedic surgeon schedules a limited cortical incision and drainage procedure to obtain bone cultures, decompress infected bone, and allow local irrigation and debridement of the superficial bone cortex.

The clinical workflow includes preoperative evaluation (labs, imaging, anesthesia assessment), informed consent describing goals (culture, decompression, preserve joint), administration of appropriate perioperative antibiotics, intraoperative incision of the bone cortex with collection of multiple deep tissue and bone cultures, irrigation and superficial bone debridement, hemostasis, and layered wound closure. Postoperative care includes culture-directed antibiotics, wound checks, pain control, mobility/weight-bearing instructions, and outpatient infectious disease follow-up for prolonged antimicrobial therapy.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure	Use when a distinct E/M is performed and documented in addition to the operative procedure (not in raw modifiers list; not used).

CPT 27036: Hip Capsule Release and Excision of Heterotopic Bone

CPT-27025-HIP-THIGH-FASCIOTOMY-DECOMPRESSION

CPT 27025: Fasciotomy, Hip or Thigh

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

CPT 27033: Open Hip Joint Exploration and Foreign Body Removal

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

CPT 27030: Hip Joint Incision, Exploration, and Drainage

CPT-27000-PERCUTANEOUS-ADDUCTOR-TENOTOMY-HIP

CPT 27000: Percutaneous Adductor Tenotomy of Hip

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

CPT 27003: Open Adductor Tenotomy with Obturator Nerve Removal

CPT-26991-HIP-BURSA-INCISION-AND-DRAINAGE

CPT 26991: Incision and Drainage of Infected Hip Bursa

CPT-27006-HIP-ABDUCTOR-EXTENSOR-OPEN-TENOTOMY

CPT 27006: Open Tenotomy of Hip Abductor/Extensor Muscles

CPT-27005-HIP-FLEXOR-OPEN-TENOTOMY

CPT 27005: Open Tenotomy of Hip Flexor Muscles

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

CPT 27035: Hip Joint Nerve Denervation for Arthritis Pain

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Taxonomy Code	Specialty	Notes
207X00000X	Orthopaedic Surgery	Primary specialty performing hip/pelvis bone procedures and debridement.
207L00000X	Adult Reconstructive Orthopedics	Subspecialists for complex hip/pelvis bone infections and joint preservation.
208000000X	General Surgery	May perform debridement in complex pelvic infections when multidisciplinary approach required.
207K00000X	Orthopaedic Trauma	Performs debridement when infection follows traumatic injury to the pelvis/hip.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M86.05`	Acute osteomyelitis, pelvis	Direct indication for cortical incision and drainage to obtain cultures and debride infected bone.
`M86.16`	Chronic osteomyelitis with draining sinus, pelvis	Chronic infection often requires surgical cortical incision and debridement for source control.
`M86.9`	Osteomyelitis, unspecified	Used when site-specific detail is not yet defined but bone infection is the target of the procedure.
`M00.85`	Staphylococcal arthritis of pelvis	Joint-associated infection may extend to adjacent bone requiring cortical incision.
`T84.7XXA`	Infection and inflammatory reaction due to internal joint prosthesis, initial encounter	If an infected hip prosthesis complicates treatment, bone cortical incision may be part of management for infection control.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`27072`	Incision and drainage, deep abscess, bursa, or hematoma of the hip or pelvis; simple or single	May be performed for deep soft-tissue abscess adjacent to bone in the same operative session.
`27080`	Debridement, muscle, fascia, and/or tendon (e.g., deep) of the hip or pelvis	Performed when deeper soft-tissue debridement beyond the cortical bone incision is required.
`11012`	Debridement including subcutaneous tissue, up to 20 cm2	Used for superficial wound debridement performed at the time of bone cortex incision.
`11042`	Debridement, subcutaneous tissue (includes epidermis and dermis), first 20 sq cm or less	Used when additional soft-tissue debridement is performed concurrently.
`20610`	Arthrocentesis, aspiration and/or injection; major joint or bursa (e.g., hip)	May be performed pre- or postoperatively for diagnostic joint aspiration or for intraarticular injections.
`27091`	Biopsy, bone, pelvic bone	May be reported when additional or more extensive bone biopsy specimens are taken beyond the cortical incision for diagnostic purposes.

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