CPT 27198: Closed Manipulation of Posterior Pelvic Fracture Under Anesthesia - OpenPayer

Summary & Overview

CPT 27198: Closed Manipulation of Posterior Pelvic Fracture Under Anesthesia

CPT code 27198 denotes closed manipulation to treat fractures or separations of the posterior pelvic bones performed under general or regional anesthesia or moderate sedation. Nationally, this code captures procedures addressing unstable pelvic ring injuries that can have significant clinical and cost implications due to the complexity of care, need for anesthesia, and potential inpatient resources. Payers commonly involved in coverage of these services include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will find a concise overview of the clinical context for CPT code 27198, typical sites of service, and the role this service plays in orthopedic and trauma care pathways. The publication outlines expected use cases, payment benchmarking elements, and relevant policy considerations for major national payers. Where available, content highlights utilization patterns, authorization and documentation considerations, and coding nuances that affect claim adjudication. Data not available in the input are noted explicitly in relevant sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 27198pelvic fractureorthopedicsclosed manipulationanesthesiasurgical proceduretrauma careinpatient surgeryambulatory surgery

Billing Code Overview

CPT code 27198 describes a procedure in which, with the patient under general or regional anesthesia or moderate sedation, the provider performs manipulation to treat a fracture and/or a complete or partial separation of one or both sides of the posterior pelvic bones, with or without an anterior component.

Service type: Closed manipulation of pelvic ring injury under anesthesia
Typical site of service: Inpatient hospital operating room or ambulatory surgical center, depending on injury severity and patient condition

Data not available in the input regarding associated taxonomies, ICD-10 diagnoses, related codes, or service line.

Clinical & Coding Specifications

Clinical Context

A typical patient is a 45-year-old pedestrian struck by a motor vehicle who presents to the emergency department with severe pelvic instability, posterior pelvic ring disruption on imaging, and hemodynamic stability after initial resuscitation. The orthopedic trauma surgeon schedules an operative closed or open manipulation of the posterior pelvic ring under general or regional anesthesia with moderate sedation to reduce fractures and/or sacroiliac joint separations. The clinical workflow includes emergency department evaluation, pelvic radiographs and CT for fracture characterization, preoperative anesthesia assessment, operative manipulation and fixation as indicated, intraoperative fluoroscopic imaging, postoperative monitoring in the PACU or trauma unit, and discharge planning with weight-bearing and physical therapy instructions. Billing uses 27198 for manipulation of posterior pelvic ring fracture/separation when performed under anesthesia.

Coding Specifications

Modifier	Description	When to Use
`62`	Two surgeons	When two surgeons work together as primary surgeons on the procedure
`63`

CPT 27248: Open Treatment of Greater Trochanteric Femur Fracture

cpt-27257-closed-treatment-developmental-hip-dislocation

CPT 27257: Closed Treatment of Developmental Hip Dislocation

cpt-27250-closed-treatment-traumatic-hip-dislocation-no-general-anesthesia

CPT 27250: Closed Treatment of Traumatic Hip Joint Dislocation, Without General Anesthesia

cpt-27226-acetabular-wall-fracture-open-fixation

CPT 27226: Open Fixation of Acetabular Wall Fracture

cpt-27252-closed-reduction-traumatic-hip-dislocation-general-anesthesia

CPT 27252: Closed Reduction of Traumatic Hip Dislocation under General Anesthesia

cpt-27258-open-treatment-hip-dislocation-with-adductor-tenotomy

CPT 27258: Open Treatment of Hip Dislocation with Adductor Tenotomy

cpt-27265-prosthetic-hip-closed-reduction-without-anesthesia

CPT 27265: Closed Reduction of Dislocated Prosthetic Hip Without Anesthesia

cpt-27236-open-treatment-femoral-neck-fracture-internal-fixation

CPT 27236: Open Treatment of Femoral Neck Fracture with Internal Fixation

cpt-27220-closed-treatment-acetabular-fracture

CPT 27220: Closed Treatment of Acetabular (Hip Socket) Fracture

cpt-27267-closed-treatment-fracture-femoral-head

CPT 27267: Closed Treatment of Femoral Head Fracture

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Taxonomy Code	Specialty	Notes
`207L00000X`	Orthopaedic Surgery	Primary specialty performing pelvic fracture manipulation and fixation
`208800000X`	Emergency Medicine	Initial ED evaluation and stabilization prior to operative management
`2086S0123X`	Critical Care Medicine	Management of hemodynamically unstable trauma patients and perioperative critical care
`207P00000X`	Surgery - Trauma	Trauma surgeons who may perform or coordinate pelvic fracture care
`207K00000X`	Anesthesiology	Provides general or regional anesthesia and moderate sedation during the procedure

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S32.80XA`	Unspecified fracture of pelvis, initial encounter for closed fracture	General pelvic fractures that may involve the posterior ring managed with manipulation
`S32.89XA`	Other fractures of pelvis, initial encounter for closed fracture	Specific posterior pelvic ring fractures or separations requiring manipulation
`S32.501A`	Fracture of sacrum, unspecified, initial encounter for closed fracture	Sacral fractures contributing to posterior pelvic ring instability treated with manipulation
`S32.6XXA`	Fracture of pubis, initial encounter for closed fracture	May be associated anterior component when posterior manipulation is performed
`S32.70XA`	Multiple fractures of pelvis, unspecified, initial encounter for closed fracture	Complex pelvic ring injuries involving posterior elements addressed with manipulation

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`27245`	Open treatment of pelvic ring disruption, anterior and posterior, with or without internal or external fixation	Often performed when open fixation of anterior and posterior elements is required in addition to manipulation
`27244`	Open treatment of posterior pelvic ring disruption (eg, iliac, sacral) with internal fixation	May be reported when open internal fixation of posterior pelvis is performed rather than manipulation alone
`20690`	Removal of fixation device (deep)	Performed later if internal fixation devices placed during pelvic surgery require removal
`76000`	Fluoroscopic guidance; simple (e.g., for localization)	Used intraoperatively for imaging to confirm reduction during manipulation
`29125`	Application, cast; pelvic and hip (Spica)	May be applied postoperatively for immobilization when indicated
`99024`	Postoperative follow-up visit, related to a previously performed procedure during the global period	Used by the surgeon for routine postoperative care visits

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