CPT 27227: Open Fixation of Acetabular Fracture - OpenPayer

Summary & Overview

CPT 27227: Open Fixation of Acetabular Fracture

CPT code 27227 denotes open surgical treatment of acetabular fractures involving a posterior or anterior column or fractures that traverse the acetabulum, using internal fixation devices such as plates, pins, wires, or screws. This procedure is a key orthopedic trauma intervention with implications for postoperative function, complication risk, and hospital resource use. Nationwide, appropriate coding and clinical documentation for this code affect surgical quality measurement, inpatient utilization reporting, and reimbursement for complex pelvic fracture care.

Major payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a national overview of how CPT code 27227 is used across care settings, summarizes typical sites of service, and outlines common clinical contexts in which the code applies.

Readers will find a concise clinical context for the procedure, guidance on documentation elements that support correct coding, and a summary of common modifiers used with the code. The report also highlights benchmarking considerations for utilization and resource intensity for complex acetabular fracture repair. Data not available in the input is noted where applicable, and the focus remains on clinical and coding clarity for national audiences including clinicians, coding professionals, and payers.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare27227CPTorthopedic surgeryacetabular fractureopen reduction internal fixationpelvic fracturesurgical fixationinpatient surgery

Billing Code Overview

CPT code 27227 describes an open treatment of an acetabular fracture involving the posterior or anterior column, or a fracture that extends across the acetabulum, using internal fixation implants such as plates and pins, wires, or screws. This procedure addresses displaced fractures of the acetabulum that require direct visualization and surgical fixation.

Service type: Open surgical fixation of acetabular fracture
Typical site of service: Inpatient or outpatient hospital operating room, depending on fracture complexity and patient condition

Clinical & Coding Specifications

Clinical Context

A 46-year-old male motorcyclist presents to the emergency department after a high-energy collision with severe left hip pain, inability to bear weight, and pelvic instability. Imaging (AP pelvis and CT scan) demonstrates a displaced posterior column acetabular fracture extending into the weight-bearing dome with intra-articular displacement. After orthopedic trauma evaluation, the patient is optimized for surgery and scheduled for open reduction and internal fixation.

Preoperative workflow includes history and physical, anesthesia evaluation, pre-op labs, cross-match if indicated, and informed consent. In the operating room, the orthopedic trauma surgeon performs an open approach (commonly Kocher-Langenbeck or ilioinguinal depending on fracture pattern), achieves anatomic reduction of the acetabular fragments, and secures fixation using plates and screws (and when indicated, supplemental pins or wires). Intraoperative fluoroscopy confirms reduction and hardware position. Postoperative care involves admission to the surgical ward or ICU as clinically indicated, pain control, DVT prophylaxis, radiographic evaluation, and a coordinated plan for limited weight-bearing and outpatient physical therapy upon discharge.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work, time, and intensity substantially exceed usual for open acetabular fixation and documentation supports additional reimbursement.

CPT 27218: Open Treatment of Posterior Pelvic Ring Fracture

cpt-27259-open-surgical-hip-reduction-femoral-shortening

CPT 27259: Open Surgical Hip Reduction with Femoral Shortening

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

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

cpt-27232-closed-treatment-femoral-neck-fracture

CPT 27232: Closed Treatment of Femoral Neck Fracture

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

CPT 27254: Open Treatment of Traumatic Hip Dislocation with Fracture

cpt-27245-femoral-fracture-intramedullary-fixation-open-treatment

CPT 27245: Open Femoral Fracture Fixation with Intramedullary Implant

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

CPT 27226: Open Fixation of Acetabular Wall Fracture

cpt-27202-open-treatment-coccyx-fracture-with-fixation

CPT 27202: Open Treatment of Coccyx Fracture with Fixation

cpt-27198-pelvic-ring-manipulation-under-anesthesia

CPT 27198: Closed Manipulation of Posterior Pelvic Fracture Under Anesthesia

cpt-27265-prosthetic-hip-closed-reduction-without-anesthesia

CPT 27265: Closed Reduction of Dislocated Prosthetic Hip Without Anesthesia

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Taxonomy Code	Specialty	Notes
207X00000X	Orthopedic Surgery	Primary specialty performing open acetabular fixation.
2080P0208X	Trauma Surgery (Orthopedic Trauma)	Subspecialists focusing on complex pelvic and acetabular fractures.
208600000X	General Surgery	Occasionally involved in combined pelvic access approaches, less commonly primary.
207K00000X	Hand Surgery	Not typical; included only when multi-specialty trauma care involves other orthopedics subspecialties.
286H00000X	Physical Medicine & Rehabilitation	Manages postoperative rehabilitation and weight-bearing progression.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S32.41`	Fracture of acetabulum, closed	Direct indication for open reduction and internal fixation when displaced.
`S32.431`	Displaced fracture of left acetabulum	Specifies laterality and displacement; commonly treated with `27227` when open fixation is required.
`S32.432`	Displaced fracture of right acetabulum	Specifies laterality and displacement for right-sided procedures.
`S32.45`	Fracture of pelvic ring, unspecified part	Used when acetabular fracture extends into the pelvic ring and combined management is necessary.
`S32.429`	Fracture of acetabulum, unspecified acetabulum	Used when documentation lacks specificity; further specification supports appropriate surgical coding.
`S32.40`	Fracture of acetabulum, unspecified whether open or closed	Used as a general code when more specific details are pending but relevance to operative fixation is high.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`27245`	Open treatment of pelvic ring disruption (eg, ilioinguinal approach), including internal fixation when performed	May be performed for associated pelvic ring injuries or when acetabular fracture extends into the pelvic ring; can be staged or combined.
`20690`	Application of external fixation device (unlisted upper/lower extremity procedures)	Used preoperatively or as temporary stabilization in severe pelvic/acetabular trauma prior to definitive ORIF.
`73530`	Radiologic examination, hip, unilateral, complete, minimum of 2 views	Preoperative and postoperative radiographs to evaluate acetabular fracture and hardware position.
`73510`	Radiologic examination, hip/s, unilateral, 1 or 2 views	Common for initial emergency department imaging assessment.
`27220`	Closed treatment of acetabular fracture; without manipulation	May be attempted for nondisplaced fractures or used prior to deciding on open fixation; contrasts with the open approach in `27227`.
`27370`	Open treatment of femoral head or neck fracture	Performed when there are associated proximal femur injuries that require concurrent management.

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