CPT 27258: Open Treatment of Hip Dislocation with Adductor Tenotomy - OpenPayer

Summary & Overview

CPT 27258: Open Treatment of Hip Dislocation with Adductor Tenotomy

CPT code 27258 captures open surgical management of spontaneous developmental hip dislocation, including reduction of the femoral head into the acetabulum combined with adductor tenotomy. This procedure is a key orthopedic intervention for congenital or pathological hip instability and has implications for surgical resource use, perioperative care pathways, and payer coverage policies across the United States. Nationally, the code reflects a high-acuity operative service typically delivered in hospitals or ambulatory surgical centers and is relevant for pediatric and adult orthopedics depending on etiology.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication summarizes payer coverage patterns and common modifier usage where available, and contextualizes the procedure within clinical care for hip dislocation.

Readers will learn what CPT code 27258 represents clinically, where the service is typically performed, and which major payers are relevant for coverage considerations. The analysis provides benchmarks and policy-relevant highlights, clarifies clinical context for surgical teams and billing staff, and identifies areas where data was not provided. Data not available in the input is called out explicitly where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare27258CPTorthopedicship dislocationopen hip reductionadductor tenotomysurgical procedureambulatory surgeryinpatient surgery

Billing Code Overview

CPT code 27258 describes an open treatment of spontaneous developmental hip dislocation, including congenital or pathological hip joint dislocation, with reduction of the femoral head into the acetabulum and an adductor muscle tenotomy performed as part of the same procedure.

Service type: Open surgical orthopedic procedure for hip reduction with soft-tissue release.

Typical site of service: Hospital inpatient or ambulatory surgical center, depending on clinical severity and postoperative needs.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 14-month-old child with a history of developmental dysplasia of the hip (DDH) presents with limited abduction, asymmetric skin folds, and an unstable hip on physical exam. Imaging (ultrasound or x‑ray) demonstrates a high-riding, dislocated femoral head requiring open reduction. The orthopedic surgeon schedules an operative open reduction of the hip with adductor tenotomy under general anesthesia in an operating room. Preoperative workflow includes informed consent, preoperative imaging review, anesthesia evaluation, and provision of antibiotics per facility protocol. Intraoperative steps include exposure of the hip joint, release of contracted soft tissues (including adductor tenotomy), reduction of the femoral head into the acetabulum, assessment of stability and hip congruity, and application of a spica cast or other immobilization as indicated. Postoperative workflow includes PACU recovery, pain management, hip imaging to confirm reduction, cast care education for caregivers, and scheduled follow‑up for cast removal and serial imaging to monitor acetabular development.

Coding Specifications

Modifier	Description	When to Use
`00`	Default/No modifier	Not typically reported; use when no other modifier applies
`22`

CPT 27248: Open Treatment of Greater Trochanteric Femur Fracture

cpt-27220-closed-treatment-acetabular-fracture

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

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

CPT 27268: Closed Reduction of Femoral Neck/Head Fracture

cpt-27256-closed-hip-dislocation-splint-traction

CPT 27256: Closed Treatment of Hip Dislocation with Splint or Traction

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

CPT 27217: Open Treatment of Anterior Pelvic Ring Fracture

cpt-27252-closed-reduction-traumatic-hip-dislocation-general-anesthesia

CPT 27252: Closed Reduction of Traumatic Hip Dislocation under General Anesthesia

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

CPT 27218: Open Treatment of Posterior Pelvic Ring Fracture

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

CPT 27238: Closed Treatment of Femoral Fracture, Stable Nondisplaced

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

CPT 27198: Closed Manipulation of Posterior Pelvic Fracture Under Anesthesia

cpt-27236-open-treatment-femoral-neck-fracture-internal-fixation

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

Showing 1–10 of 35

Taxonomy Code	Specialty	Notes
207T00000X	Orthopaedic Surgery	Pediatric and adult hip open reduction procedures performed by orthopedic surgeons
2080P0206X	Pediatric Orthopedic Surgery	Subspecialty focus on pediatric hip disorders such as DDH
207K00000X	Surgery — General	General surgeons rarely perform this; included for coding assignment in some organizations
2086S0128X	Pediatric Medicine	Pediatricians coordinate perioperative care and follow‑up but do not perform the surgery
363L00000X	Anesthesiology	Anesthesiology providers deliver general anesthesia and perioperative management

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Q65.0`	Congenital dislocation of hip, unilateral	Classic diagnosis leading to open reduction with adductor tenotomy in infants and young children
`Q65.1`	Congenital dislocation of hip, bilateral	Bilateral dislocations that may require staged or simultaneous bilateral open reductions
`M24.35`	Recurrent dislocation, shoulder (use caution)	Data not applicable to hip — placeholder removed per input constraints
`M21.0`	Unspecified acquired deformity of limb (non-specific)	May be used when hip deformity is described prior to definitive coding for DDH or sequelae
`M16.11`	Unilateral primary osteoarthritis, hip, right	Included only when secondary osteoarthritic changes necessitate corrective surgery in older patients

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`27258`	Open treatment of hip dislocation; includes reduction of femoral head and adductor tenotomy	Primary procedure: open reduction with adductor tenotomy for developmental or pathologic hip dislocation
`27310`	Surgical procedures on hip joint; arthrotomy with exploration, drainage, or debridement	May be performed if joint exploration or debridement is required prior to or during open reduction
`27146`	Osteotomy, femoral, proximal (e.g., varus, derotation)	Often performed concurrently or staged when femoral osteotomy is required to improve hip stability
`27130`	Osteotomy, acetabular (e.g., Salter, Pemberton)	Pelvic/acetabular osteotomy frequently accompanies open reduction to improve acetabular coverage
`11981`	Injection, therapeutic; soft tissue trigger point(s) (single or multiple)	May be used for perioperative pain management in select outpatient settings (adjunctive service)

OpenPayer