CPT 27218: Open Treatment of Posterior Pelvic Ring Fracture
CPT code 27218 denotes open treatment of a posterior pelvic ring fracture or dislocation with internal fixation on one side of the pelvis. This procedure is a key surgical intervention for pelvic ring disruptions that compromise stability, mobility, and the ability to bear weight. Nationally, accurate coding for these complex orthopedic procedures affects hospital billing, resource allocation, and quality measurement for trauma and orthopedic services.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, and the service type. The publication also summarizes common billing considerations, commonly reported modifiers, and where CPT code 27218 fits within surgical and trauma care pathways.
This overview prepares clinical, billing, and policy audiences to understand benchmark interpretations, payer coverage patterns, and policy updates that influence authorization and claim adjudication for open pelvic fixation procedures. Data not available in the input is noted where applicable.
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Billing Code Overview
CPT code 27218 describes an open treatment of a posterior pelvic ring disruption on one side of the pelvis. The procedure involves surgical exposure of the posterior pelvic bone and may include internal fixation using devices such as plates and screws to restore pelvic ring stability.
Service type: Open surgical fixation of posterior pelvic ring fracture or dislocation
Typical site of service: Inpatient hospital or ambulatory surgery center (operating room)
Clinical & Coding Specifications
Clinical Context
A 42-year-old male motorcyclist presents to the emergency department after a high-energy collision with pelvic pain, instability, and inability to bear weight. Imaging (pelvic radiographs and CT) demonstrates a displaced posterior pelvic ring fracture through the ilium and sacroiliac region with disruption of the pelvic ring on one side. The patient is hemodynamically stable after resuscitation and is scheduled for operative management.
Preoperative workflow includes trauma evaluation, surgical consent, cross-sectional imaging review, and coordination with anesthesia and blood bank. In the operating room, the orthopedic trauma or pelvic reconstruction surgeon performs an open reduction and internal fixation of the posterior pelvic ring fracture using plates and screws (and possible supplemental sacroiliac screws). Intraoperative fluoroscopy confirms reduction and hardware placement. Postoperative care includes pain control, DVT prophylaxis, mobility planning with physical therapy, and follow-up radiographs to confirm continued alignment and healing. Typical hospitalization ranges from short observation to several days depending on concomitant injuries and recovery.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | When the procedure is performed on the left pelvis/hip region |
RT | Right side | When the procedure is performed on the right pelvis/hip region |
50 | Bilateral procedure | When both left and right posterior pelvic procedures are performed during the same operative session |
62 | Two surgeons | When two surgeons work together as primary surgeons performing distinct portions of the procedure |
80 | Assistant surgeon | When a surgical assistant is present and provides surgical assistance |
81 | Minimum assistant surgeon | When a minimally invasive assistant (per payer rules) participates |
82 | Assistant surgeon (unrelated) | When an assistant is required but does not meet typical criteria for assistant at surgery |
22 | Increased procedural services | For unusual procedural complexity or extended operative time beyond typical for the procedure |
52 | Reduced services | When the service provided is partially reduced or not completed as originally planned |
53 | Discontinued procedure | When the procedure is started but terminated due to extenuating circumstances |
78 | Return to OR for related procedure during postoperative period | When the patient returns to the operating room for a related procedure during the global period |
79 | Unrelated procedure or service by the same physician during the postoperative period | When an unrelated procedure is performed during the global period |
58 | Staged or related procedure during the postoperative period | For planned staged reconstruction or delayed definitive fixation following temporary stabilization |
26 | Professional component | When billing only the professional component separate from technical component (rare for surgical CPTs) |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207L00000X | Orthopaedic Surgery | Orthopedic trauma/pelvic reconstruction surgeons who perform open fixation of pelvic ring fractures |
2080P0226X | General Surgery | Trauma/general surgeons may participate in multispecialty trauma cases or provide concurrent care |
208VP0000X | Physical Medicine & Rehabilitation | Provides post-acute functional recovery and coordination of rehabilitation after fixation |
213E00000X | Emergency Medicine | Initial evaluation and stabilization in emergency setting prior to operative fixation |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
S32.501A | Unspecified fracture of pelvis, initial encounter for closed fracture | Common presenting diagnosis for pelvic ring fractures requiring operative fixation |
S32.502A | Unspecified fracture of pelvis, initial encounter for open fracture | Pelvic fractures with open wounds may require operative debridement and fixation |
S32.431A | Fracture of sacrum, initial encounter for closed fracture | Sacral fractures can disrupt posterior pelvic stability and often require fixation |
S32.451A | Fracture of iliac wing, initial encounter for closed fracture | Iliac wing fractures may be part of unilateral posterior ring disruption addressed by this procedure |
S32.189A | Other fracture of pubis, initial encounter for closed fracture | Anterior ring involvement often accompanies posterior disruptions; coding captures associated injuries |
S32.409A | Fracture of acetabulum, unspecified, initial encounter for closed fracture | Complex pelvic-acetabular injuries may coexist and influence surgical approach |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
72192 | Computed tomography, pelvis; without contrast | Preoperative cross-sectional imaging to characterize pelvic fracture patterns and surgical planning |
73502 | Radiologic examination, hip, centers on two views; unilateral | Initial radiographs of the pelvis/hip to identify fracture and guide urgency of fixation |
27096 | Percutaneous skeletal fixation of pelvic ring fracture (e.g., iliosacral screw), with image guidance | May be performed as an alternative or adjunct to open fixation for select posterior pelvic ring injuries |
20680 | Removal of deep implant; requiring major incision and/or complicated exposure | Possible later procedure for removal of plates or screws if hardware becomes symptomatic or infected |
99024 | Postoperative follow-up visit, typical global period (hospital) | Represents routine postoperative hospital follow-up care during the global surgical package |