Summary & Overview
CPT 27178: Closed Reduction and Percutaneous Pinning for Slipped Femoral Epiphysis
CPT code 27178 represents closed reduction and percutaneous pinning for slipped femoral epiphysis, an important pediatric orthopaedic procedure used to restore and stabilize the femoral head following a physeal slip. Nationally, this code captures a high-acuity, operative intervention for adolescents and other skeletally immature patients where timely reduction and fixation can prevent further displacement and reduce long-term hip dysfunction.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for the procedure, expected sites of service, and commonly applied modifiers. The publication summarizes benchmark payment considerations and common billing practices for hospital and ambulatory surgical settings, highlights coding pitfalls to avoid, and outlines areas where policy updates or payer-specific edits most frequently affect claim adjudication.
This summary is intended for revenue cycle leaders, orthopaedic surgeons, and coding professionals seeking a national perspective on use and billing of CPT code 27178, including operational and policy-relevant considerations.
Billing Code Overview
CPT code 27178 describes a surgical procedure to treat slipped femoral epiphysis by closed reduction and percutaneous pinning. The provider first performs a manipulation to reduce the slipped femoral epiphysis, restoring alignment of the femoral head (epiphysis) on the femoral neck. The reduced epiphysis is then secured through a small incision using one or more pins inserted across the physis to stabilize the slip.
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Service type: Surgical orthopaedic procedure for stabilization of slipped femoral epiphysis
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Typical site of service: Hospital operating room or ambulatory surgical center for pediatric orthopaedic surgery
Clinical & Coding Specifications
Clinical Context
A 13-year-old adolescent male presents to the emergency department after an acute onset of progressive left hip pain and limp following a minor fall while playing. On exam he has limited internal rotation and external rotation with leg length discrepancy. Pelvic and hip radiographs demonstrate a mild-to-moderate slipped capital femoral epiphysis (SCFE) of the left proximal femur. The orthopedic surgeon performs closed reduction under general anesthesia in the operating room, confirms improved alignment with fluoroscopy, makes a small lateral proximal femoral incision, and obtains percutaneous placement of a single cannulated screw across the proximal femoral physis to stabilize the reduced epiphysis. Postoperative care includes recovery from anesthesia, radiographic confirmation of hardware position, admission for analgesia and non–weight-bearing instructions, and outpatient follow-up for screw removal or monitoring of growth and hip function. Typical workflow: emergency/urgent evaluation → imaging (AP/lateral hip) → preoperative consent and anesthesia evaluation → closed reduction and percutaneous pinning (27178) in an operating room or ambulatory surgery center → postoperative radiographs and discharge planning.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default unspecified modifier | Rarely used; only if payer requires a placeholder when no other modifier applies |