Summary & Overview
CPT 27181: Intertrochanteric Osteotomy for Slipped Femoral Epiphysis with Fixation
CPT code 27181 denotes an open intertrochanteric osteotomy with internal fixation performed to correct a slipped femoral epiphysis in pediatric patients. Nationally, this code captures a specialized orthopedic surgical service that addresses a growth-plate fracture of the proximal femur; timely and appropriate coding affects surgical case mix reporting, payment bundling, and quality measurement for pediatric and adolescent orthopedic care. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. This publication explains the clinical context of the procedure, typical sites of service, and common billing considerations. Readers will find benchmarks for utilization and reimbursement patterns, relevant coding practice notes, and policy updates that influence coverage and prior authorization for complex pediatric orthopedic surgery. The report also outlines clinical indicators that commonly accompany use of this code and practical documentation elements that support correct code selection. Data limitations are noted where input fields were not provided. The intent is to provide a concise reference for billers, practice managers, and policy analysts focused on surgical coding, reimbursement, and pediatric orthopedic service lines.
Billing Code Overview
CPT code 27181 describes an open treatment of slipped femoral epiphysis with intertrochanteric osteotomy and internal fixation. The procedure involves removing a wedge-shaped portion of bone from the femoral neck to correct displacement of the femoral epiphysis (growth plate) and using internal fixation implants to stabilize the correction. This intervention addresses slipping of the femoral epiphysis seen in growing children due to a fracture through the physis.
Service type: Surgical — Orthopedic corrective osteotomy with internal fixation
Typical site of service: Inpatient or outpatient hospital operating room or ambulatory surgery center, depending on patient age, clinical complexity, and perioperative requirements.
Clinical & Coding Specifications
Clinical Context
A 13-year-old adolescent male presents with progressive limp, groin pain, and limited internal rotation of the hip after several weeks of activity-related discomfort. Radiographs demonstrate a slipped capital femoral epiphysis (SCFE) with posterior-inferior displacement of the proximal femoral epiphysis. The orthopedic surgeon schedules an open corrective osteotomy with internal fixation to realign the femoral neck and stabilize the physis.
Preoperative workflow includes history and physical, informed consent, pre-op imaging (AP and frog-leg lateral pelvis radiographs, and optional MRI if instability or early slip suspected), and anesthesia evaluation. Intraoperative steps include open exposure of the femoral neck, wedge resection (intertrochanteric/neck-level osteotomy) to correct the deformity, reduction of the slip, and placement of internal fixation hardware (screws/plates) to stabilize the correction. Postoperative care includes inpatient monitoring for pain and neurovascular status, early mobilization per weight-bearing restrictions, physical therapy, and radiographic follow-up to assess healing and hardware position. Anticipated typical site of service is an inpatient or hospital-based outpatient surgical setting; procedure is performed by pediatric or adult orthopedic surgeons with expertise in pediatric hip disorders.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
62 | Two surgeons | Use when two surgeons work together as primary surgeons performing distinct parts of the procedure (complex deformity requiring dual-surgeon approach). |