Summary & Overview
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.
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 |