CPT 27122: Acetabuloplasty with Femoral Head Resection
CPT code 27122 represents a major orthopedic surgical procedure in which the surgeon performs an acetabuloplasty and resects the femoral head to address severe hip infection or irreparable joint damage. Nationally, this code captures care for patients requiring salvage or infection-directed hip surgery when reconstruction is not feasible; it is clinically significant because these cases are high-acuity, resource-intensive, and may involve complex perioperative management.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, payer coverage considerations, common modifiers associated with surgical billing, and an overview of related service-line implications. The publication summarizes typical sites of service and service type, and describes what benchmarks and policy topics are relevant for organizations managing these cases.
This summary provides clinicians, billing professionals, and policy analysts with a national view of CPT code 27122, clarifying its clinical intent and administrative relevance. Data not available in the input are identified where applicable in the full publication.
Sign up for cpt 27122 policy alerts
Get alerted when payer policies referencing 27122 are released or updated.
Billing Code Overview
CPT code 27122 describes a surgical procedure that combines acetabuloplasty (reshaping the acetabulum, the socket of the hip joint) with resection of the femoral head. The procedure is performed to relieve pain and remove infected or nonviable bone when the hip cannot be reconstructed, commonly in the setting of severe hip infection or irreparable joint damage.
-
Service type: Surgical orthopedic procedure involving removal and reshaping of hip joint structures
-
Typical site of service: Inpatient or outpatient hospital operating room, depending on patient acuity and infection status
Clinical & Coding Specifications
Clinical Context
A 68-year-old male with a long-standing history of severe osteomyelitis of the hip and a chronically infected, nonfunctional hip joint presents with uncontrolled pain, drainage, and systemic inflammatory markers despite prolonged antibiotics. The orthopedic surgeon determines that joint-preserving reconstruction is not feasible because of extensive acetabular bone loss and a grossly destroyed femoral head. The patient is scheduled for an acetabuloplasty with femoral head resection to remove infected and nonviable bone, relieve pain, and control local sepsis.
Preoperative workflow includes history and physical, laboratory evaluation (CBC, inflammatory markers), targeted imaging (plain radiographs and CT of the pelvis to assess bone loss), and perioperative antibiotics per infectious disease guidance. The procedure is performed in an operating room with general or regional anesthesia. Intraoperative steps include surgical approach to the hip (commonly posterior or lateral), debridement of infected soft tissue, acetabuloplasty to reshape and resect diseased acetabular bone as indicated, resection (excision) of the femoral head, thorough irrigation, and placement of drains or local antibiotic carriers when indicated. Postoperative care involves inpatient monitoring for infection control, pain management, wound care, and coordination with physical therapy for limited weight-bearing or assistive device use. Subsequent plans may include staged reimplantation or definitive arthrodesis or prosthetic reconstruction only if infection is eradicated and bone stock permits.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
50 | Bilateral procedure | When both hips undergo acetabuloplasty/femoral head resection in the same operative session. |
52 | Reduced services | If the procedure is started but not completed or substantially reduced in scope. |
53 | Discontinued procedure | When the procedure is halted due to an intraoperative complication and not completed. |
54 | Surgical care only | Append when only the surgical component is billed and another provider bills pre/postoperative care. |
55 | Postoperative management only | Use when the surgeon bills only for postoperative follow-up care. |
62 | Assistant surgeon required | When an assistant surgeon (not an assistant at surgery under modifier 80) is necessary for complexity. |
66 | Surgical team or co-surgery | For documented co-surgeon or team-based approach requiring shared responsibility. |
78 | Return to OR for related procedure during global period | For unplanned return to the OR for a complication related to the original surgery within the global period. |
79 | Unrelated procedure or service during the postoperative period (Note: 79 is not in the provided list; excluded) | Data not provided — excluded per input constraints. |
76 | Repeat procedure by same physician (Note: 76 is not in the provided list; excluded) | Data not provided — excluded per input constraints. |
63 | Procedures on infants less than 4 kg (pediatric weight modifier) | When patient qualifies by weight and payer allows adjustment. |
22 | Increased procedural services | For substantially greater work than typical due to severe infection, extensive debridement, or abnormal anatomy. |
23 | Unusual anesthesia — patient condition | When general anesthesia is contraindicated and an unusual anesthetic is required due to patient condition. |
52 | Reduced services | Duplicate removed — already listed above. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207X00000X | Orthopaedic Surgery | Primary specialty performing acetabuloplasty and femoral head resection. |
| 207L00000X | Orthopaedic Trauma | Often involved when severe infection follows prior trauma or fixation. |
| 2080P0003X | Physical Medicine & Rehabilitation | Manages postoperative rehabilitation and functional recovery. |
| 208000000X | Surgery (General) | Rarely involved for complex infection cases requiring broad surgical coordination. |
| 208000000X | Infectious Disease (Note: taxonomy for ID is often 207RG0300X) | Provides antibiotic management and perioperative infection planning. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
M86.251 | Other acute osteomyelitis, pelvic region | Osteomyelitis of the acetabulum or proximal femur indicating need for debridement and resection. |
M86.251 | Chronic osteomyelitis, pelvic region (if present as chronic form code M86.261 depending on laterality) | Chronic bone infection leading to joint destruction requiring resection. |
M00.85 | Pyogenic arthritis, pelvis and thigh | Septic arthritis of the hip joint contributing to destruction of the femoral head and acetabulum. |
M16.9 | Osteoarthritis of hip, unspecified | Severe degenerative joint disease with inability to reconstruct may necessitate resection in select cases. |
T84.7XXA | Infection and inflammatory reaction due to internal joint prosthesis, initial encounter | For infected prosthetic hip requiring removal of prosthesis and resection when reconstruction is not feasible. |
M84.5X1 | Pathological fracture, hip, due to bone infection or neoplasm | Pathologic bone compromise that can necessitate femoral head resection as part of management. |
C41.4 | Malignant neoplasm of pelvic bones, sacrum and coccyx | Tumor-related destruction of acetabulum/femoral head that may require resection for palliation or control. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
11042 | Debridement, subcutaneous tissue (simple) | May be used if extensive soft-tissue debridement of infected tissue is billed separately in the same operative episode. |
11043 | Debridement, muscle and fascia | Used when deeper debridement into muscle/fascia is required for infection control in the hip region. |
27030 | Arthrotomy, hip, with debridement, synovectomy, or resection of loose body | Related therapeutic/diagnostic debridement procedures that can be performed in the same surgical setting. |
27299 | Unlisted procedure, pelvis/hip joint | Used for atypical or highly specialized pelvic/acetabular reconstructions not described by existing codes. |
20610 | Arthrocentesis, large joint with or without injection | Perioperative or diagnostic joint aspiration for culture and diagnosis prior to definitive surgery. |