Summary & Overview

CPT 27228: Open Treatment of Complex Acetabular Fracture

CPT code 27228 denotes the open surgical treatment of complex acetabular fractures — high-acuity orthopedic procedures that restore hip socket anatomy and joint function. Nationally, this code is important for hospital-based trauma and orthopedic surgery billing and contributes substantially to inpatient surgical case mix and resource utilization. Common payers in national analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will find a concise overview of clinical context for CPT code 27228, benchmarks for utilization and reimbursement across major payers, and relevant policy and coding considerations that affect hospital billing and credentialed orthopedic practices. The publication summarizes typical sites of service, coding nuances, and common modifier use where available. It also highlights areas where payers commonly review claims for medical necessity and documentation tied to complex acetabular fracture repair.

This material provides a national perspective intended for revenue cycle leaders, orthopedic clinicians, and health policy analysts seeking operational and payment context for high-acuity orthopedic trauma procedures.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 27228acetabular fractureorthopedic surgeryhip fracture repairopen fracture treatmentinpatient surgeryoperative management

Billing Code Overview

CPT code 27228 describes an open treatment of a complex fracture of the acetabulum, the cup-shaped socket of the hip joint. This procedure involves surgical exposure of the hip socket to reduce and internally fix comminuted or displaced acetabular fractures.

Service type: Open surgical fracture management
Typical site of service: Inpatient hospital operating room or ambulatory surgical center when clinically appropriate

Clinical & Coding Specifications

Clinical Context

A 45-year-old male presents after a high-energy motor vehicle collision with severe left hip pain, inability to bear weight, and pelvic instability. Imaging (pelvic radiographs and CT) demonstrates a displaced, comminuted posterior column acetabular fracture with intra-articular extension and marginal impaction. The orthopedic trauma team schedules an open reduction and internal fixation of the acetabulum under general anesthesia using extensile exposure, plate and screw fixation, and possible bone grafting.

Preoperative workflow includes advanced trauma life support stabilization, neurovascular exam documentation, informed consent describing open treatment of a complex acetabular fracture, and surgical planning with CT reconstructions. Intraoperative activities include fluoroscopic guidance, an extensile or posterior approach to the acetabulum, direct visualization and reduction of fragments, fixation with reconstruction plates and screws, and irrigation with closure. Postoperative workflow includes radiographic confirmation of reduction, pain control, thromboprophylaxis, weight-bearing restrictions, physical therapy planning, and documentation of operative findings, implants, and estimated blood loss for billing and quality reporting.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the procedure required substantially greater work than usual due to complexity, extensive dissection, or prolonged operative time.
`23`	Unusual anesthesia	Use when medically necessary anesthesia is required but general anesthesia is not administered; rare for this procedure.
`26`	Professional component	Use if billing only the physician professional component for imaging or interpretation related to the procedure (rare for primary surgeon billing).
`50`	Bilateral procedure	Use if bilateral acetabular open treatments are performed in the same operative session.
`51`	Multiple procedures	Use when additional unrelated surgical procedures are performed at the same operative session in addition to the open acetabular fixation.
`52`	Reduced services	Use when the service was partially reduced or not completed as planned (e.g., aborted fixation due to patient instability).
`53`	Discontinued procedure	Use when the procedure is started but discontinued for reasons such as intraoperative instability.
`62`	Two surgeons	Use when two surgeons with distinct skills perform portions of the procedure (e.g., combined orthopedic trauma and pelvic reconstruction specialists).
`78`	Unplanned return to OR (related)	Use for a return to the operating room for a related procedure during the global period (e.g., washout or revision for infection).
`79`	Unrelated procedure or service	Use when a subsequent procedure during the postoperative period is unrelated to the original acetabular fixation.
`81`	Minimum assistant surgeon	Use when an assistant provides minimal assistance and billing criteria for an assistant surgeon apply.
`82`	Assistant surgeon (when qualified resident not available)	Use when an assistant surgeon is required and a qualified resident is not available.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services	Use when an advanced practice clinician performs portions of the service within scope and billing rules.
`LT`	Left side	Use to indicate the left acetabulum side when laterality is required by payer.
`RT`	Right side	Use to indicate the right acetabulum side when laterality is required by payer.

Taxonomy Code	Specialty	Notes
`207T00000X`	Orthopaedic Trauma Surgery	Primary specialty performing complex acetabular open reduction and internal fixation.
`207L00000X`	Orthopaedic Surgery	General orthopedists who manage pelvic and acetabular fractures.
`2080P0206X`	Surgery - Trauma	Trauma surgeons who may participate in multi-disciplinary pelvic fixation.
`208000000X`	General Surgery	Occasionally involved for combined pelvic procedures or stabilization in polytrauma scenarios.
`364S00000X`	Anesthesiology	Provides general or regional anesthesia and perioperative pain management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S32.451A`	Displaced fracture of acetabulum, left, initial encounter for closed fracture	Common primary diagnosis indicating a displaced acetabular fracture requiring open reduction and internal fixation.
`S32.452A`	Displaced fracture of acetabulum, right, initial encounter for closed fracture	Right-sided displaced acetabular fracture treated with open fixation.
`S32.459A`	Unspecified acetabular fracture, initial encounter for closed fracture	Used when laterality or exact pattern is not specified in initial documentation.
`S32.431A`	Fracture of posterior column of acetabulum, left, initial encounter for closed fracture	Posterior column fractures often require open reduction via posterior approach.
`S32.432A`	Fracture of posterior column of acetabulum, right, initial encounter for closed fracture	Right-sided posterior column fracture indicating similar surgical management.
`S32.441A`	Fracture of anterior column of acetabulum, left, initial encounter for closed fracture	Anterior column fractures may require alternative approaches for ORIF.
`S32.491A`	Fracture of acetabulum with pelvic ring disruption, initial encounter	Indicates more complex injury pattern and potential multidisciplinary management.
`S72.001A`	Fracture of unspecified part of femur, initial encounter for closed fracture	Included because associated femoral fractures can coexist and affect surgical planning.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`27236`	Open treatment of femoral head or neck (intracapsular) fracture, with internal fixation, when performed	May be performed if associated femoral head or neck fracture requires fixation during same operative session.
`20680`	Removal of implant; deep (e.g., buried plates, intramedullary devices)	Performed later if implants require planned removal or in case of infection or hardware failure.
`76000`	Fluoroscopic guidance (radiologic) during procedures (eg, real-time imaging)	Commonly used intraoperatively for fracture reduction and hardware placement confirmation.
`73502`	Radiologic examination, pelvis, 2-3 views	Preoperative or postoperative plain radiographs to document fracture and fixation.
`72195`	Computed tomography, pelvis, without contrast	Preoperative CT used for fracture characterization and surgical planning.
`27447`	Arthroplasty, knee, with or without total joint replacement components	Not directly related to acetabular fixation but may appear in the surgical record if staged joint procedures occur; included as a less common related pelvic/hip procedure.