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

Summary & Overview

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

CPT code 27236 covers the open surgical management of femoral neck fractures, typically using internal fixation devices such as pins, wires, or screws, and may include partial replacement of the damaged bone with an implant when indicated. This code is relevant nationally because femoral neck fractures are common in trauma and geriatric populations and represent a significant portion of orthopedic surgical workload and acute care resource utilization. Accurate coding affects clinical documentation, hospital case mix, and payment for operative orthopedic care.

Key payers addressed in this publication include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and typical settings for service, followed by benchmark considerations and coding nuances that influence claims processing. The article summarizes common modifiers and related administrative topics (Data not available in the input for taxonomies, ICD-10 mappings, and related codes) and highlights where policy updates or payer-specific rules can affect reimbursement and prior authorization practices.

This analysis provides clinicians, coders, and revenue professionals with practical context for correct application of CPT code 27236, expected sites of service, and the clinical scenarios it represents, enabling clearer documentation and more consistent billing across payers nationally.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare27236CPTorthopedic surgeryfemoral neck fractureinternal fixationhip fractureoperative procedurehospital inpatientambulatory surgery

Billing Code Overview

CPT code 27236 describes an open treatment of femoral neck fracture. The procedure involves surgical exposure of the proximal femur to reduce and fix a fracture of the femoral neck using internal fixation devices such as pins, wires, or screws. The procedure may include partial replacement of the damaged bone with an artificial implant when necessary.

Service type: Surgical — Orthopedic fracture fixation / possible partial prosthetic replacement

Typical site of service: Operating room in an acute care hospital or ambulatory surgery center, depending on patient status and clinical needs.

Clinical & Coding Specifications

Clinical Context

A 78-year-old female presents to the emergency department after a ground-level fall at home with immediate left hip pain and inability to bear weight. Radiographs demonstrate a displaced femoral neck fracture of the left hip. The orthopedic team evaluates the patient, reviews medical comorbidities (including osteoporosis, anticoagulation status, and cardiopulmonary risk), and determines that open internal fixation with possible partial arthroplasty is indicated. The patient is taken to the operating room under general or regional anesthesia. The surgeon performs an open reduction and internal fixation of the femoral neck fracture using screws and/or pins (CPT 27236), with intraoperative fluoroscopy to confirm alignment and hardware position. If the head or femoral neck is nonviable, the surgeon may convert to hemiarthroplasty during the same anesthetic. Postoperative workflow includes recovery room monitoring, venous thromboembolism prophylaxis, pain control, early mobilization with physical therapy, and discharge planning to home with home health or to an acute rehabilitation facility depending on functional status and social supports. Typical documentation includes preoperative informed consent, operative report detailing fixation method and implants, anesthesia record, and postoperative instructions.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased Procedural Services

CPT 27216: Pelvic External Fixation for Pelvic Ring Injury

cpt-27220-closed-treatment-acetabular-fracture

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

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

CPT 27198: Closed Manipulation of Posterior Pelvic Fracture Under Anesthesia

cpt-27197-posterior-pelvic-fracture-treatment-no-manipulation

CPT 27197: Treatment of Posterior Pelvic Fracture/Separation Without Manipulation

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

CPT 27202: Open Treatment of Coccyx Fracture with Fixation

cpt-27235-percutaneous-fixation-femoral-neck-fracture

CPT 27235: Percutaneous Fixation of Femoral Neck Fracture

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

CPT 27267: Closed Treatment of Femoral Head Fracture

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

CPT 27265: Closed Reduction of Dislocated Prosthetic Hip Without Anesthesia

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

CPT 27254: Open Treatment of Traumatic Hip Dislocation with Fracture

cpt-27217-open-treatment-anterior-pelvic-ring-fracture-fixation

CPT 27217: Open Treatment of Anterior Pelvic Ring Fracture

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Taxonomy Code	Specialty	Notes
`207X00000X`	Orthopaedic Surgery	Primary specialty performing open treatment and fixation of femoral neck fractures.
`2080P0208X`	General Surgery (Trauma/Both)	Trauma surgeons manage high-energy or polytrauma femoral neck fractures in some centers.
`2086S0121X`	Orthopaedic Trauma	Subspecialty focused on fracture fixation and perioperative fracture care.
`2084P0800X`	Hospitalist (perioperative management)	Manages medical optimization and comorbid conditions pre- and postoperatively.
`207L00000X`	Physical Medicine & Rehabilitation	Oversees postoperative rehabilitation planning and inpatient/outpatient therapy coordination.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S72.001A`	Fracture of head of right femur, initial encounter for closed fracture	Displaced femoral neck fractures of the femoral head/neck necessitating open fixation or arthroplasty.
`S72.002A`	Fracture of head of left femur, initial encounter for closed fracture	Left-sided femoral head/neck fractures addressed with `CPT 27236`.
`S72.011A`	Fracture of intertrochanteric section of right femur, initial encounter for closed fracture	Nearby proximal femur fracture patterns that may require different fixation but appear in differential coding.
`S72.012A`	Fracture of intertrochanteric section of left femur, initial encounter for closed fracture	Left intertrochanteric fractures that may influence choice of fixation versus arthroplasty.
`M80.00XA`	Age-related osteoporosis with current pathological fracture, unspecified site, initial encounter for fracture	Osteoporotic bone increases risk of femoral neck fracture and influences fixation strategy and implant selection.
`W19XXXA`	Unspecified fall initial encounter	Common mechanism of injury leading to femoral neck fractures in older adults.
`S72.141A`	Nondisplaced fracture of neck of right femur, initial encounter for closed fracture	Nondisplaced neck fractures may be managed with percutaneous or open fixation; included for completeness of proximal femur fracture spectrum.
`S72.142A`	Nondisplaced fracture of neck of left femur, initial encounter for closed fracture	Left-sided nondisplaced femoral neck fracture relevant to fixation coding and treatment planning.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`27096`	Open treatment of pelvic fracture, includes internal fixation when performed	May be performed in concomitant pelvic fractures or when pelvic fixation is required during the same admission.
`27020`	Closed treatment of acetabular fracture (no internal fixation)	Performed in patients with associated acetabular injury where nonoperative management is chosen; may be part of initial management decisions.
`27125`	Hemiarthroplasty, hip, partial (e.g., femoral head replacement)	Performed when the femoral head is nonviable or fracture pattern warrants replacement instead of fixation; may be done intraoperatively as a conversion.
`27130`	Total hip arthroplasty, primary	Performed when fracture management requires total hip replacement rather than fixation or hemiarthroplasty, typically in displaced fractures in active elderly patients or where acetabular disease exists.
`20690`	Application of external fixation device (uniplanar or multiplanar)	Used for temporary or definitive external stabilization in polytrauma or contaminated wounds prior to definitive internal fixation.
`73502`	Radiologic examination, hip, unilateral, without contrast (single view)	Preoperative and postoperative radiographs used to diagnose fracture and confirm hardware position; commonly ordered in the perioperative workflow.

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