CPT 27202: Open Treatment of Coccyx Fracture with Fixation - OpenPayer

Summary & Overview

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.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare27202CPTOpen fracture fixationOrthopedic surgeryCoccyx fractureSurgical codingAmbulatory surgical centerHospital operating room

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 (document rationale).

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

cpt-27254-open-treatment-hip-dislocation-acetabular-femoral-fracture

CPT 27254: Open Treatment of Traumatic Hip Dislocation with Fracture

cpt-27269-open-reduction-femoral-head-fracture-internal-fixation

CPT 27269: Open Reduction of Femoral Head Fracture, Possible Internal Fixation

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

CPT 27257: Closed Treatment of Developmental Hip Dislocation

cpt-27238-closed-treatment-femoral-fracture-stable-nondisplaced

CPT 27238: Closed Treatment of Femoral Fracture, Stable Nondisplaced

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

CPT 27226: Open Fixation of Acetabular Wall Fracture

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

CPT 27267: Closed Treatment of Femoral Head Fracture

cpt-27222-closed-treatment-acetabular-fracture

CPT 27222: Closed Treatment of Acetabular (Hip Socket) Fracture

cpt-27220-closed-treatment-acetabular-fracture

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

cpt-27244-femoral-fracture-plate-and-screw-fixation-open-treatment

CPT 27244: Open Femoral Fracture Fixation with Plate and Screws

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CPT 27202

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`.

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