Summary & Overview
CPT 27052: Open Biopsy of Hip Soft Tissue
CPT code 27052 represents an open surgical biopsy of soft tissue in the hip joint. This code is used when a provider makes an incision to access the hip and removes tissue for diagnostic testing, typically to evaluate infection, malignancy, or unexplained inflammatory conditions. Nationally, accurate coding for open hip biopsies affects clinical documentation, hospital and ambulatory surgery center billing, and diagnostic workflows.
Key payers commonly involved in coverage and reimbursement decisions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for surgical hip biopsy, typical sites of service, and the major payer landscape. The publication also summarizes common billing considerations, benchmarks and utilization patterns where available, and policy issues relevant to coverage and prior authorization. This resource is intended to clarify code definition and operational implications for clinicians, coding professionals, and policy analysts working at a national level.
Billing Code Overview
CPT code 27052 describes an open surgical procedure in which the provider makes an incision to access the hip joint and obtains a biopsy of soft tissue. This procedure involves direct visualization and cutting into the hip region to collect tissue for diagnostic evaluation.
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Service type: Surgical, open biopsy of hip soft tissue
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Typical site of service: Hospital operating room or ambulatory surgery center, depending on clinical complexity and patient condition
Clinical & Coding Specifications
Clinical Context
A 52-year-old patient presents with persistent lateral hip pain and a palpable mass near the greater trochanter after several months of failed conservative therapy (NSAIDs, physical therapy). Imaging (MRI) demonstrates a suspicious soft-tissue lesion within the hip joint capsule adjacent to the labrum. The orthopedic surgeon schedules an open hip biopsy to obtain tissue for histopathology and microbiology.
Preoperative workflow includes informed consent, review of imaging, coagulation assessment, and preoperative antibiotics per facility protocol. In the operating room under general or regional anesthesia, a surgical incision is made over the hip to expose the joint and lesion. The surgeon obtains representative soft-tissue biopsy specimens, achieves hemostasis, and closes the wound. Specimens are sent for frozen section if immediate intraoperative decision-making is needed, and for permanent histology and culture. Postoperative care includes wound monitoring, pain control, mobility as tolerated, and follow-up to review pathology results.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Not typically appended; reserved for internal use. |
11 |