Summary & Overview

CPT 27269: Open Reduction of Femoral Head Fracture, Possible Internal Fixation

CPT code 27269 represents an open reduction procedure for fractures of the femoral head, with the option to apply internal fixation. This surgical code captures definitive operative management for proximal femoral fractures and is relevant to orthopedic trauma, perioperative planning, and hospital billing systems nationwide. Its use signals a higher-intensity surgical intervention with implications for facility resource use, length of stay, and postoperative care.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the code, common sites of service, and the types of services captured by the code. The publication provides benchmarks and policy-relevant information on reimbursement patterns, coding comparators, and documentation considerations tied to fracture care and open reduction procedures.

This summary is intended for clinicians, coding professionals, and revenue leaders seeking a national-level briefing on code definition, typical care settings, and what to expect when 27269 appears on the claim. Data not available in the input is noted where applicable; readers will gain practical clarity on the code’s clinical scope and typical operational implications without state-specific references.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare27269CPTorthopedic surgeryopen reductionfemoral head fractureinternal fixationsurgical codingtrauma

Billing Code Overview

CPT code 27269 describes an open reduction procedure to treat a fracture of the head of the femur (thigh bone). The procedure may include application of internal fixation to restore alignment and stability of the femoral head.

Service Type: Surgical fracture care — open reduction with possible internal fixation

Typical Site of Service: Inpatient or outpatient surgical setting (operating room or ambulatory surgery center) depending on clinical status and facility capability.

Clinical & Coding Specifications

Clinical Context

A 72-year-old female presents to the emergency department after a ground-level fall at home with acute left hip pain, inability to bear weight, and external rotation of the lower extremity. Imaging (AP pelvis and lateral hip radiographs, with CT when indicated) demonstrates a displaced femoral neck fracture involving the head of the femur. After medical optimization and anesthesiology clearance, the orthopedic trauma team schedules an open reduction and internal fixation procedure to anatomically reduce the fracture and stabilize the femoral head/neck with appropriate internal fixation devices.

The clinical workflow includes preoperative evaluation (history, focused musculoskeletal exam, imaging review, medical clearance), informed consent, operating room scheduling, performance of 27269 (open reduction of femoral head/neck fracture with possible internal fixation), intraoperative imaging (fluoroscopy), postoperative recovery in PACU, pain control and DVT prophylaxis, physical therapy initiation with weight-bearing instructions per fixation stability, and follow-up radiographs to confirm healing and hardware position.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required is substantially greater than typical for `27269` due to complexity (document rationale).
`23`	Unusual anesthesia	Use when general anesthesia cannot be used and an unusual anesthesia circumstance applies (document).
`26`	Professional component	Rare for this surgical procedure; use if reporting only the surgeon's professional component separate from facility billing in atypical billing structures.
`50`	Bilateral procedure	Use when open reduction and fixation are performed on both femoral heads during the same operative session.
`51`	Multiple procedures	Use when `27269` is performed with other surgical procedures at the same operative session; append to lesser-valued procedures per payer rules.
`52`	Reduced services	Use when the procedure was partially reduced or not completed as planned (document reason).
`53`	Discontinued procedure	Use when the procedure was started but terminated for patient safety reasons prior to completion.
`62`	Two surgeons	Use when two surgeons work together as co-surgeons performing distinct portions of `27269`.
`63`	Procedure performed on infants less than 4 kg	Use when applicable to extremely low-weight pediatric patients (rare for femoral head fractures).
`78`	Unplanned return to the operating room following initial procedure	Use when a patient returns to the OR for a related procedure during the postoperative global period.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use when an unrelated procedure is performed by the surgeon during the global period.
`80`	Assistant surgeon	Use when an assistant at surgery (not a co-surgeon) performs part of the procedure.
`81`	Minimum assistant surgeon	Use when only minimal assistance is provided by another surgeon.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when an APP serves as an assistant at surgery per payer policy.

Taxonomy Code	Specialty	Notes
207X00000X	Orthopaedic Surgery	Primary specialty performing `27269` for femoral head/neck fractures.
2080P0001X	Orthopedic Trauma	Subspecialists frequently manage complex open reductions and fixation.
2086S0105X	Adult Reconstructive Orthopedics	May manage femoral neck/head fractures, particularly when fixation vs arthroplasty decision is required.
207L00000X	General Surgery	Occasionally involved in polytrauma or when general surgeons assist in complex trauma settings.
363L00000X	Anesthesiology	Provides perioperative anesthesia care; listed as supporting specialty rather than performing the procedure.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S72.0X0A`	Fracture of neck of femur, unspecified, initial encounter for closed fracture	Classic code for femoral neck fractures treated with open reduction and possible internal fixation.
`S72.0X1A`	Fracture of neck of femur, displaced, initial encounter for closed fracture	Displaced femoral neck fractures frequently require open reduction and fixation (`27269`).
`S72.00A`	Fracture of head of femur, unspecified, initial encounter for closed fracture	Fractures involving the femoral head may be addressed with open reduction and fixation.
`S72.14XA`	Pertrochanteric fracture of right femur, initial encounter for closed fracture	Proximal femur fractures in the trochanteric region can coexist or be confused with femoral neck/head injuries; fixation approach differs but related in workflow.
`M84.451A`	Pathologic fracture, right femur, initial encounter for fracture	Pathologic fractures of the proximal femur may necessitate open reduction with internal fixation and oncologic consideration.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`27030`	Open treatment of pelvic fracture, posterior column, includes internal fixation when performed	Performed when pelvic ring or acetabular extension requires open fixation in conjunction with femoral head/neck fracture management.
`27235`	Open treatment of femoral shaft fracture, with or without external fixation; single or multiple fragments	Performed when the femoral shaft fracture exists concurrently and requires fixation in the same operative session.
`27130`	Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty)	Alternative or subsequent procedure when fracture pattern or patient factors favor arthroplasty over fixation.
`20690`	Removal of implanted material, deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)	Performed later if hardware from `27269` requires planned or unplanned removal.
`76000`	Fluoroscopic guidance; first image	Intraoperative fluoroscopy frequently used during `27269` to confirm reduction and hardware placement; facility may bill imaging guidance codes per payer rules.
`99223`	Initial hospital care, typically 70 minutes or more	Example of an appropriate hospital inpatient admission E/M code for complex preoperative evaluation of an elderly trauma patient undergoing `27269`.