CPT 27226: Open Fixation of Acetabular Wall Fracture - OpenPayer

Summary & Overview

CPT 27226: Open Fixation of Acetabular Wall Fracture

CPT code 27226 represents open surgical repair of a posterior or anterior acetabular wall fracture with internal fixation (plates, pins, or screws). This orthopedic trauma procedure is performed to restore acetabular stability, joint congruity, and to reduce the risk of post-traumatic arthritis. Nationally, acetabular fracture care has implications for trauma systems, hospital surgical capacity, and payer coverage for complex inpatient and same-day surgical episodes.

Key payers referenced in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines what readers should expect about clinical context, common sites of service, and payer coverage considerations for this procedure.

Readers will learn: benchmarks for service utilization and site-of-service patterns where available; how CPT code 27226 is described and applied in clinical documentation; and policy-relevant facts that affect billing and reimbursement for open acetabular wall fixation. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare27226CPTacetabular fractureorthopedic surgeryopen fracture fixationsurgical procedurestrauma surgeryhip fracture fixation

Billing Code Overview

CPT code 27226 describes an open treatment of an acetabular wall fracture (posterior or anterior) using internal fixation implants such as plates, pins, or screws. The procedure involves surgical exposure of the acetabulum and direct fixation of the fractured posterior or anterior wall to restore joint stability and anatomic alignment.

Service Type: Open surgical fracture fixation (orthopedic trauma surgery)

Typical Site of Service: Inpatient hospital or ambulatory surgical center, depending on clinical status and complexity

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult who sustained a high-energy pelvic injury after a motor vehicle collision or a fall from height and presents with severe hip pain, inability to bear weight, and radiologic evidence of an acetabular wall fracture (posterior or anterior). Initial evaluation occurs in the emergency department with trauma survey, pelvic and hip radiographs, and CT pelvis with 3D reconstructions to define fracture pattern. After stabilization and appropriate clearance by trauma and medical services, an orthopedic trauma surgeon schedules open reduction and internal fixation of the acetabular wall using plates, screws, and/or pins. The procedure is performed in an inpatient operating room under general anesthesia with intraoperative fluoroscopy. Postoperatively the patient is monitored for neurovascular status, received DVT prophylaxis, and undergoes physical therapy with weight-bearing restrictions determined by fixation stability. Subsequent follow-up visits include wound checks, radiographic assessment of fracture healing, and gradual progression of weight bearing.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the procedure requires substantially greater work than usual due to complexity, extensive dissection, or intraoperative complications.
`23`

CPT 27240: Closed Treatment of Femoral Fracture Near Trochanters

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

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

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

CPT 27238: Closed Treatment of Femoral Fracture, Stable Nondisplaced

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

CPT 27257: Closed Treatment of Developmental Hip Dislocation

cpt-27215-iliac-spine-tuberosity-avulsion-iliac-wing-fixation

CPT 27215: Open Fixation of Iliac Spine/Tuberosity/Iliac Wing Fracture

cpt-27268-closed-reduction-femoral-neck-fracture

CPT 27268: Closed Reduction of Femoral Neck/Head Fracture

cpt-27253-open-treatment-hip-joint-dislocation-no-fixation

CPT 27253: Open Treatment of Hip Joint Dislocation, No Internal Fixation

cpt-27218-open-treatment-posterior-pelvic-ring-fracture-fixation

CPT 27218: Open Treatment of Posterior Pelvic Ring Fracture

cpt-27227-open-fixation-acetabular-fracture

CPT 27227: Open Fixation of Acetabular Fracture

cpt-27246-closed-treatment-greater-trochanteric-fracture

CPT 27246: Closed Treatment of Greater Trochanteric Femur Fracture

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Taxonomy Code	Specialty	Notes
207X00000X	Orthopaedic Surgery	Primary specialty performing acetabular open reduction internal fixation procedures.
207L00000X	Orthopaedic Trauma Surgery	Subspecialty focused on complex pelvic and acetabular fractures.
208000000X	General Surgery	May be involved in multisystem trauma or combined approaches in complex cases.
2086S0123X	Surgical Critical Care	Provides perioperative critical care management for unstable trauma patients.
261QM0800X	Anesthesiology	Provides intraoperative anesthesia care and perioperative pain management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S32.41`	Fracture of acetabulum, posterior wall	Posterior wall acetabular fractures are a core indication for open reduction and internal fixation using plates and screws.
`S32.42`	Fracture of acetabulum, anterior wall	Anterior wall fractures of the acetabulum often require open fixation to restore hip stability and joint congruity.
`S32.43`	Fracture of acetabulum, transverse	Transverse patterns may extend to walls and are often managed with open fixation techniques.
`S32.49`	Fracture of acetabulum, other parts of acetabulum	Miscellaneous acetabular fracture locations that may need open reduction and internal fixation.
`S32.47`	Fracture of acetabulum, both columns	Complex fracture pattern involving both columns frequently requires open fixation and sometimes combined approaches.
`S72.00`	Fracture of unspecified part of femur	Associated ipsilateral femoral fractures can occur with acetabular fractures and may be addressed concomitantly.
`M84.37`	Pathologic fracture, pelvis and hip, due to other cause	Pathologic fractures involving the acetabulum may occasionally need fixation though management differs clinically.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`27220`	Closed treatment of acetabular fracture, without manipulation, with or without skeletal traction	May be performed prior to or instead of open fixation for nondisplaced fractures or temporizing management.
`27224`	Open treatment of acetabular fracture (e.g., transverse), posterior wall; with internal fixation	Closely related open fixation code used for other acetabular fracture patterns; may be billed for different fracture locations.
`27535`	Open treatment of femoral shaft fracture, including internal fixation, when femoral fixation is required concurrently	Performed when associated femoral fractures require fixation during the same operative session.
`20690`	Removal of implant; deep (e.g., buried)	May be performed at a later date for hardware removal if symptomatic or after healing.
`77002`	Fluoroscopic guidance for fracture reduction and fixation (intraoperative real-time)	Used to report intraoperative fluoroscopic guidance during placement of implants for acetabular fixation.
`99100`	Anesthesia for patient of extreme age, younger than 1 year and older than 70 (add-on)	May be reported as appropriate for anesthesia complexity in elderly trauma patients (use per payer rules).

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