CPT 27197: Treatment of Posterior Pelvic Fracture/Separation Without Manipulation
CPT code 27197 denotes surgical treatment of fractures and/or partial or complete separations of the posterior pelvic ring, with or without an anterior component, performed without manipulation. The code captures procedures addressing posterior pelvic instability and fracture patterns that require operative management but do not involve manipulation maneuvers. Nationally, this code is used in hospital and ambulatory surgical settings for trauma and orthopedic surgical care, and it is relevant for payment, utilization monitoring, and quality measurement for pelvic fracture management.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will gain a concise understanding of the clinical scope of CPT code 27197, typical sites of service, and how the code is positioned within surgical pelvic fracture care. The publication summarizes common billing modifiers and coding context (provided separately), discusses expected care settings, and outlines considerations for coverage and claims processing. It also highlights typical clinical scenarios where the code is applied and notes where additional documentation or related procedure codes may be needed. Data not available in the input is explicitly noted where applicable.
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Billing Code Overview
CPT code 27197 describes treatment of a fracture and/or a complete or partial separation of one or both sides of the posterior pelvic bones (the back portion of the pelvis), with or without an anterior component, performed without manipulation. This procedure addresses pelvic ring injuries involving the posterior elements.
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Service type: Surgical treatment of posterior pelvic fracture/separation without manipulation
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Typical site of service: Hospital inpatient or outpatient surgical setting, including operating room or ambulatory surgery center, depending on clinical severity and patient stability.
Clinical & Coding Specifications
Clinical Context
A 68-year-old male presents to the emergency department after a low-energy fall at home with pelvic pain, difficulty weight-bearing and localized posterior pelvic tenderness. Imaging (pelvic radiographs and CT) demonstrates a sacral fracture with widening of the posterior pelvic ring without evidence of gross displacement requiring open manipulation. The orthopaedic trauma surgeon evaluates the patient, documents fracture type and neurovascular status, reviews imaging, discusses nonoperative versus operative options, and performs a closed management procedure to treat the fracture and/or partial separation of the posterior pelvic ring (sacroiliac joints or sacrum) without manipulation under anesthesia. Typical workflow includes ED evaluation, imaging, orthopaedic consultation, informed consent, procedure performed in the operating room or procedure suite without open reduction or manipulation, postoperative pain control and discharge planning or inpatient admission for observation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normal, uncomplicated post-operative care | Use when provider is the primary surgeon and service is routine without complications |
22 | Increased procedural services | Use when documentation supports substantially greater work than typical for the procedure |
23 | Unusual anesthesia | Use when procedure is performed under general anesthesia when normally local/regional would be expected |
25 | Significant, separately identifiable E/M on same day | Use when a significant evaluation and management visit is performed on same day as procedure |
50 | Bilateral procedure | Use when identical procedure is performed on both sides of the pelvis and supported by documentation |
52 | Reduced services | Use when the service was partially reduced or not completed as planned |
53 | Discontinued procedure | Use when procedure is started but then terminated for patient-related or safety reasons |
54 | Surgical care only | Use when reporting only the surgical component and another provider reports postoperative care |
55 | Postoperative management only | Use when reporting only postoperative management |
62 | Two surgeons | Use when two surgeons work together as primary surgeons performing distinct portions |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207L00000X | Orthopaedic Surgery | Primary specialty managing pelvic ring and sacral fractures |
| 2086S0122X | Orthopedic Trauma Surgery | Subspecialty focused on complex pelvic and acetabular injuries |
| 208D00000X | General Surgery | May be involved for multi-system trauma cases with pelvic fractures |
| 174400000X | Emergency Medicine | Initial evaluation, stabilization, and triage |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
S32.4 | Fracture of sacrum | Directly describes sacral fractures and posterior pelvic ring injuries treated by this procedure |
S32.5 | Fracture of coccyx | Adjacent posterior pelvic injury that may be evaluated in the same clinical context |
S32.6 | Fracture of ilium | Iliac fractures can involve the posterior pelvis and influence management |
S32.7 | Multiple fractures of pelvis | Used when multiple pelvic elements, including posterior structures, are fractured |
S32.89 | Other fractures of pelvis | Captures other posterior pelvic fractures not otherwise specified |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
27235 | Open treatment of iliac wing, sacral, or pelvic fracture; internal fixation | Performed when open fixation is required after closed treatment is not sufficient |
27244 | Open treatment of pelvic ring disruption (anterior and/or posterior) with internal fixation | Used for more extensive pelvic ring disruptions requiring open reduction and internal fixation |
20680 | Removal of deep implant; complicated | Performed later if internal fixation hardware from other pelvic procedures requires removal |
73502 | Radiologic examination, pelvis, 1 or 2 views | Initial imaging study often obtained in ED evaluation prior to definitive treatment |
72195 | Computed tomography, pelvis, without contrast | Cross-sectional imaging frequently used to define sacral fracture pattern and posterior ring injury |