CPT 27266: Closed Reduction of Dislocated Prosthetic Hip - OpenPayer

Summary & Overview

CPT 27266: Closed Reduction of Dislocated Prosthetic Hip

CPT code 27266 denotes a closed reduction of a dislocated hip in a patient with a prior total hip arthroplasty, performed under regional or general anesthesia. This code captures an acute, typically operative procedure to restore alignment of a prosthetic hip without open surgical intervention. It is clinically significant because postoperative dislocation is a common and costly complication of total hip replacement, and timely closed reduction can prevent further morbidity and the need for revision surgery.

Key national payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for 27266, typical sites of service, and the procedural scope of care. The publication also summarizes benchmark considerations and policy-relevant topics such as coding specificity, anesthesia setting, and when closed reduction is the appropriate service designation.

This resource is intended to orient clinicians, coders, and policy analysts to the core clinical definition and billing context of CPT code 27266, and to highlight the areas where payers and national policy intersect with clinical management and billing practice.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare27266CPThip-dislocationclosed-reductionorthopedicstotal-hip-replacementoperative-procedureanesthesia

Billing Code Overview

CPT code 27266 describes a closed treatment procedure for a minor dislocation of a hip joint following a prior total hip replacement. The provider performs a forceful manual or mechanical realignment of the prosthetic hip while the patient is under a regional or general anesthetic.

Service type: Closed corrective procedure for a prosthetic hip dislocation
Typical site of service: Operating room or procedure suite under regional or general anesthesia

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 72-year-old patient with a prior total hip arthroplasty presents to the emergency department with acute onset hip pain and an externally rotated, shortened lower extremity after a low-energy fall at home. Imaging confirms a posterior dislocation of the prosthetic femoral head from the acetabular component. The orthopedic surgeon proceeds with an urgent closed reduction of the prosthetic hip under a regional (spinal) or general anesthetic in the operating room or procedure suite. Pre-reduction steps include informed consent, neurovascular exam documentation, review of prior implant type and stability, and perioperative antibiotic and thromboprophylaxis planning as indicated. Post-reduction, the provider documents successful concentric reduction on fluoroscopy or radiographs, performs a focused neurovascular reassessment, and documents post-procedure weight-bearing and activity restrictions, discharge instructions, and plans for follow-up with outpatient orthopedic clinic for implant evaluation and potential revision planning if instability recurs.

Coding Specifications

Modifier	Description	When to Use
`23`	Unusual anesthesia	Use when the procedure is performed with general anesthesia for an otherwise normally not anesthetized procedure or when anesthesia is more than local/monitored care.
`22`

CPT 27238: Closed Treatment of Femoral Fracture, Stable Nondisplaced

cpt-27215-iliac-spine-tuberosity-avulsion-iliac-wing-fixation

CPT 27215: Open Fixation of Iliac Spine/Tuberosity/Iliac Wing Fracture

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

CPT 27202: Open Treatment of Coccyx Fracture with Fixation

cpt-27200-closed-treatment-coccyx-fracture

CPT 27200: Closed Treatment of Coccyx (Tailbone) Fracture

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

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

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

CPT 27265: Closed Reduction of Dislocated Prosthetic Hip Without Anesthesia

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

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

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

CPT 27198: Closed Manipulation of Posterior Pelvic Fracture Under Anesthesia

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

CPT 27218: Open Treatment of Posterior Pelvic Ring 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 hip reductions and arthroplasty management.
208000000X	Orthopaedic Surgery of the Hip	Subspecialty focus on hip arthroplasty and revisions.
2084P0902X	Orthopedic Trauma Surgery	Manages acute dislocations and associated traumatic injury.
163W00000X	Nurse Anesthetist	Provides regional or general anesthesia for the procedure.
207L00000X	Sports Medicine (Orthopaedic)	May manage prosthetic instability and nonoperative reductions in some practices.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`T84.01XA`	Dislocation of internal joint prosthesis, initial encounter	Directly indicates a dislocation of a prosthetic hip requiring reduction.
`T84.02XA`	Displacement of internal joint prosthesis, initial encounter	Related to prosthetic malposition or displacement which may present similarly and require reduction or revision.
`S72.001A`	Fracture of unspecified part of neck of femur, initial encounter for closed fracture	Associated trauma that can accompany prosthetic dislocation and alter management.
`M25.661`	Pain in right hip	Symptom code that may accompany prosthetic instability prompting evaluation.
`M25.662`	Pain in left hip	Symptom code relevant to side-specific presentations.
`M16.11`	Unilateral primary osteoarthritis, right hip	Underlying degenerative disease leading to prior arthroplasty; relevant historical diagnosis.
`M16.12`	Unilateral primary osteoarthritis, left hip	As above for the left side.
`Z96.641`	Presence of right artificial hip joint	Status code documenting presence of prosthetic hip joint relevant for encounter and coding.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`27266`	Closed treatment of hip dislocation, prosthetic (e.g., reduction of prosthetic hip dislocation); with anesthesia	Primary procedure: closed reduction of a dislocated total hip arthroplasty under anesthesia.
`20690`	Application of external fixation device (unlisted code for complex temporary stabilization)	May be used if temporary external stabilization is required after reduction in complex or unstable cases.
`27130`	Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty)	Related definitive procedure if closed reduction fails and revision or reimplantation is required.
`73610`	Radiologic examination, ankle and foot; complete, 3 views (Note: placeholder example of radiology; for hips use `73520`)	Imaging support: pre- and post-reduction radiographs to document alignment; for hips typically `73520` is used for radiographs of the hip.
`73520`	Radiologic examination, hip, unilateral; 2 or 3 views	Pre- and post-reduction imaging to confirm prosthetic component position and concentric reduction.
`99100`	Anesthesia for patient of extreme age, younger than 1 year and older than 70 years, requiring the presence of an additional anesthesiologist (historical/rare)	Ancillary anesthesia coding considerations for elderly patients; usage depends on payer policy.

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