Summary & Overview

CPT 27265: Closed Reduction of Dislocated Prosthetic Hip Without Anesthesia

CPT code 27265 represents a closed reduction of a dislocated hip following total hip arthroplasty, performed without general anesthesia. This procedure is a targeted, often urgent intervention to restore joint alignment of a prosthetic hip and can occur in hospital outpatient departments, emergency departments, or ambulatory surgical centers. Nationally, proper coding of this service affects clinical records, hospital throughput, and payer adjudication for post-arthroplasty complications.

Key payers commonly relevant to coverage and claims processing include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for prosthetic hip dislocations, expected sites of service, and the typical service description for coding purposes. The publication also summarizes benchmarks and payer coverage patterns where available, highlights relevant policy considerations for claims handling, and clarifies documentation elements that commonly affect claim acceptance. Data not available in the input is noted where specific payer policies, ICD-10 pairings, or related code mappings are absent.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 27265hip reductionorthopedicsprocedural codingpost-arthroplasty complicationclosed reductionoutpatient procedureemergency department

Billing Code Overview

CPT code 27265 describes a manual closed reduction of a dislocated hip prosthesis following a prior total hip replacement. The procedure involves the provider using controlled force to realign a minor dislocation of the hip joint without the use of general anesthesia.

Service type: Closed reduction of prosthetic hip dislocation
Typical site of service: Hospital outpatient department or emergency department; may also occur in ambulatory surgical centers depending on facility capabilities

Clinical & Coding Specifications

Clinical Context

A 72-year-old patient with a prior total hip arthroplasty presents to the emergency department with acute onset of hip pain and inability to bear weight after rising from a chair. Orthopedic evaluation confirms a minor prosthetic hip dislocation without fracture on plain radiographs. The patient is hemodynamically stable, neurologic and vascular exam of the limb is intact, and no general anesthesia is required or requested. The orthopedic surgeon performs a closed reduction of the prosthetic hip using manual traction and manipulation in the ED or outpatient procedure area, with conscious sedation avoided. Post-reduction radiographs confirm concentric joint alignment. The clinical workflow includes initial assessment, imaging, informed consent, closed reduction under procedural sedation or in this scenario without anesthesia, post-procedure imaging, neurovascular reassessment, and discharge instructions with activity limitations and follow-up with the arthroplasty surgeon.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure	Use when an E/M encounter is distinct from the reduction (e.g., new acute evaluation that required separate decision-making before reduction).
`52`	Reduced service	Use when the closed reduction is partially reduced or the full procedure was not completed as described.
`53`	Discontinued procedure	Use if the attempt at closed reduction was started but terminated due to patient instability or complication.
`59`	Distinct procedural service	Use to indicate a distinct service when multiple procedures are reported the same day and not usually bundled.
`62`	Two surgeons	Use when two surgeons from different specialties perform portions of the procedure requiring distinct skills.
`66`	Surgical team approach	Use when multiple surgeons provide distinct parts of care as a team.
`73`	Discontinued outpatient hospital/ASC procedure prior to anesthesia administration	Use if the attempt at reduction was cancelled before anesthesia or the intended procedure started in an ambulatory setting.
`74`	Discontinued outpatient hospital/ASC procedure after anesthesia administration	Not typical for this code (no anesthesia), included when applicable.
`78`	Unplanned return to the operating/procedure room for a related procedure during the postoperative period	Use if a subsequent unplanned procedure for the same hip occurs emergently.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use when an unrelated procedure is performed in the postoperative period.
`LT`	Left side	Use to designate the left hip when laterality is required.
`RT`	Right side	Use to designate the right hip when laterality is required.
`51`	Multiple procedures	Use when more than one distinct procedure is performed the same day; applies when reduction accompanies another reportable procedure.
`22`	Unusual procedural services	Use when the reduction requires significantly more work or complexity than typical.

Taxonomy Code	Specialty	Notes
207X00000X	Orthopedic Surgery	Primary specialty performing closed reduction of prosthetic hip dislocation.
2080P0207X	Emergency Medicine	Performs bedside closed reductions in ED settings.
311500000X	Physical Medicine & Rehabilitation	May perform in select settings for prosthetic joint management and follow-up.
207L00000X	Orthopedic Surgery of the Lower Extremity	Subspecialty focus often managing arthroplasty complications.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`T84.04XA`	Dislocation of internal prosthetic right hip joint, initial encounter	Common diagnosis indicating prosthetic hip dislocation on the right side requiring closed reduction.
`T84.05XA`	Dislocation of internal prosthetic left hip joint, initial encounter	Common diagnosis indicating prosthetic hip dislocation on the left side requiring closed reduction.
`M16.11`	Unilateral primary osteoarthritis, right hip	Underlying disease leading to total hip arthroplasty and potential subsequent prosthetic instability.
`M16.12`	Unilateral primary osteoarthritis, left hip	As above for the left hip.
`T84.09XA`	Dislocation of other internal prosthetic joint, initial encounter	Used when laterality or exact joint specification differs; captures prosthetic joint dislocation.
`S73.01XA`	Dislocation of right hip, initial encounter	Native hip dislocation differential diagnosis; relevant if native joint involvement must be distinguished.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`27265`	Closed treatment of prosthetic hip dislocation; without anesthesia	Primary procedure: closed reduction of a dislocated total hip arthroplasty without anesthesia.
`27096`	Manipulation of hip joint under anesthesia for reduction of dislocation	Alternative when reduction requires anesthesia; used if general or regional anesthesia is used for reduction.
`73030`	Radiologic examination, hip, 2 views	Pre- and post-reduction radiographs to confirm dislocation and successful reduction.
`73050`	Radiologic examination, pelvis, 2 or more views	Used when pelvis imaging is clinically indicated to assess component position or associated pelvic injury.
`99024`	Postoperative follow-up visit, during global period	Used for routine postop follow-up visits after the reduction during the global period when applicable.
`99152`	Moderate sedation services provided by the same physician performing the procedure (initial 15 minutes)	Used when conscious sedation is provided for reduction; not typically used when no anesthesia is administered.