Summary & Overview
CPT 27245: Open Femoral Fracture Fixation with Intramedullary Implant
CPT code 27245 denotes open surgical treatment of femoral shaft fractures between, around, or below the trochanters using an intramedullary implant, often with interlocking screws or cerclage. This procedure is a common orthopedic intervention for stabilizing unstable femoral fractures and has significant implications for hospital surgical services, device utilization, and perioperative care nationally. It is typically performed in hospital operating rooms or ambulatory surgery centers depending on patient acuity.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise policy and billing overview, clinical context for when the procedure is appropriate, common payer coverage patterns, and coding considerations that affect claim adjudication. The publication highlights typical service settings, procedural components inherent to the code description, and common modifiers used in practice (input list provided). Where payer-specific benchmarks or policies are available, the report summarizes contrasts among major commercial insurers and Medicare to aid revenue cycle and compliance teams.
This summary is intended for clinical coders, orthopedic surgery administrators, and revenue cycle professionals seeking a national perspective on coding, billing, and operational issues tied to CPT code 27245. Data not available in the input will be identified as such in the detailed sections.
Billing Code Overview
CPT code 27245 describes an open treatment of femoral fracture between, around, or below the trochanters with placement of an intramedullary implant. The provider stabilizes fractured femoral segments by inserting an implant into the femoral canal; fixation may include interlocking screws and/or cerclage (a metal band or wire loop) to secure fragments.
Service Type: Open surgical fracture fixation with intramedullary implant
Typical Site of Service: Inpatient or outpatient hospital operating room; ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A typical patient is a middle-aged to elderly adult who presents to the emergency department after a fall or high-energy trauma with acute right or left thigh pain, inability to bear weight, deformity, or limb shortening. Imaging (plain radiographs and often CT) confirms a femoral shaft or proximal femoral fracture between, around, or below the trochanters. The orthopedic trauma team evaluates the patient, obtains medical clearance, and proceeds to the operating room for open reduction and internal fixation with an intramedullary implant. The clinical workflow includes preoperative antibiotics, anesthesia assessment (general or regional), open reduction of the fracture, insertion of an intramedullary nail through the femoral canal with interlocking screws and optional cerclage wires as needed for fragment control, intraoperative fluoroscopic imaging, wound closure, postoperative immobilization and pain control, and inpatient or outpatient follow-up for radiographic healing and weight-bearing progression. Documentation should include operative indication, fracture location and pattern, implant type and sizes, use of interlocking screws or cerclage, intraoperative findings, complications (if any), estimated blood loss, and disposition.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Reserved / Not used for Medicare payment adjustments | Rarely used; follow payer-specific guidance |