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.
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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.
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Service type: Closed manipulation of pelvic ring injury under anesthesia
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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 | Procedure performed on infants less than 4 kg | When applicable for very small infants (rare for pelvic procedures) |
73 | Discontinued outpatient procedure prior to anesthesia administration | If the case is cancelled after the patient goes to the OR but before anesthesia |
74 | Discontinued outpatient procedure after anesthesia administration | If procedure is started under anesthesia and then discontinued (Note: 74 is not in the provided list; do not use) |
78 | Unplanned return to the OR following initial procedure for related procedure during postoperative period | For unexpected return to OR for revision or complication |
79 | Unrelated procedure or service by the same physician during the postoperative period | For unrelated procedures during global period |
50 | Bilateral procedure | When manipulation/fixation is performed on both sides of the posterior pelvic ring |
51 | Multiple procedures | When 27198 is reported with another distinct procedure during the same operative session |
52 | Reduced services | When the service provided is partially reduced or not completed as originally planned |
53 | Procedure discontinued on request of patient | If the procedure is halted at patient request after anesthesia |
80 | Assistant surgeon | When an assistant surgeon performed a portion of the procedure |
81 | Minimum assistant surgeon | When minimal assistant involvement documented |
82 | Assistant surgeon (when qualified resident not available) | When an assistant surgeon is necessary because a qualified resident is not available |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | When an advanced practitioner assists at surgery |
| 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 |