CPT 27202: Open Treatment of Coccyx Fracture with Fixation
CPT code 27202 denotes the open surgical treatment of a coccyx (tailbone) fracture, often involving internal fixation with pins or screws. This code captures operative management when direct exposure and implant fixation are required, making it relevant to surgical, orthopedic, and trauma care pathways. Nationally, accurate use of this code matters for procedure tracking, facility reimbursement, and quality measurement in musculoskeletal trauma care.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for operative coccyx fracture management, typical sites of service (hospital operating room and ambulatory surgical center), and the billing considerations that commonly accompany open fracture fixation procedures. The publication summarizes typical modifiers and payers observed for this service and highlights common coding relationships and service-line placement.
This resource helps clinicians, billing professionals, and payers understand when CPT code 27202 applies, the clinical scenarios that generate its use, and the operational settings where the procedure is performed. Data not available in the input is noted where applicable.
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Billing Code Overview
CPT code 27202 describes the open treatment of a coccyx fracture, involving direct surgical exposure of the coccyx to reduce and fix the fracture. The procedure may include the use of internal fixation implants such as pins or screws to stabilize the fracture and promote healing.
Service Type: Surgical — Open fracture fixation
Typical Site of Service: Hospital operating room or ambulatory surgical center, where operative management and implant fixation are performed.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult who presents after a fall onto the buttocks or a direct blow to the coccyx with severe localized pain, focal tenderness, bruising, swelling, and difficulty sitting. Initial evaluation includes history, physical exam, and pelvic radiographs or CT to confirm a displaced or unstable coccyx fracture. Conservative care (analgesics, sitting cushions, activity modification) is attempted first; open treatment with internal fixation (CPT 27202) is considered when the fracture is displaced, unstable, chronically symptomatic after conservative management, or when fractures are associated with pelvic ring injuries requiring surgical stabilization.
Preoperative workflow includes informed consent, preoperative medical clearance, imaging review, and surgical planning for possible fixation hardware (pins, screws). The procedure is performed in an operating room with the patient prone, using fluoroscopic guidance as needed. Postoperative care includes pain control, wound care, activity restrictions, and follow-up imaging to confirm fixation and healing. Rehabilitation may include graduated sitting tolerance and physical therapy for gait and core stabilization if indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | When work or resources substantially exceed typical for CPT 27202 (document rationale). |
23 | Unusual anesthesia | If general anesthesia is used specifically because of patient condition making local/regional anesthesia contraindicated. |
26 | Professional component | When reporting only the surgeon’s professional component separate from technical facility billing (rare for this code). |
50 | Bilateral procedure | If bilateral coccygeal surgical procedures are performed (apply when appropriate). |
51 | Multiple procedures | When CPT 27202 is billed with additional surgical procedures at the same session (report as modifier 51 per payer rules). |
52 | Reduced services | If the procedure is partially reduced or not completed as planned. |
53 | Discontinued procedure | If the procedure is started but terminated due to extenuating circumstances. |
62 | Two surgeons | When two surgeons participate and both perform distinct portions of a complex fixation. |
63 | Procedure performed on infants less than 4 kg | Use only if the patient meets weight/age criteria and payer recognizes modifier 63. |
78 | Return to OR for related procedure during global period | If a return to the operating room for a related procedure occurs during the global period. |
79 | Unrelated procedure or service during the postoperative period | (Not in provided list) Data not available in the input. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207L00000X | Orthopaedic Surgery | Most common specialty performing open fixation of coccyx fractures. |
| 2080P0207X | Colorectal Surgery | May be involved for coccygeal injuries related to pelvic floor or rectal proximity in complex cases. |
| 2086S0121X | Surgery of the Pelvis | Surgeons focusing on pelvic reconstruction or trauma often manage these fractures. |
| 208000000X | General Surgery | May perform fixation when trauma coverage or subspecialty not available. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
S32.2 | Fracture of coccyx | Primary diagnosis directly indicating a coccyx fracture that may require open fixation coded with CPT 27202. |
S32.5 | Fracture of sacrum | Sacral involvement often coexists with coccygeal injury and influences surgical planning. |
S32.4 | Fracture of sacrum and coccyx, combined | Indicates combined injury pattern where coccyx fixation is part of broader pelvic stabilization. |
S32.89 | Other fractures of pelvis | Pelvic ring or adjacent fractures that may be addressed in the same operative setting. |
M54.5 | Low back pain | Symptom-level code that may appear in outpatient follow-up but is nonspecific; used when pain persists post-injury. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
20690 | Removal of deep implant; e.g., deep removal of implant such as pins or screws | May be performed later if hardware becomes symptomatic or infected following CPT 27202. |
27096 | Open treatment of sacral fracture, with or without internal fixation | Performed when coccygeal fracture is associated with sacral fractures requiring additional fixation. |
27020 | Open treatment of pelvic fracture, anterior approach, with internal fixation | May be used in conjunction when pelvic ring injuries accompany the coccyx fracture. |
11042 | Debridement, subcutaneous tissue (for wound management) | May be performed if postoperative wound complication requires debridement after coccyx fixation. |
99223 | Initial hospital care, typically 70 minutes or more | Example of an appropriate inpatient initial evaluation code for complex trauma patients undergoing CPT 27202. |