Summary & Overview
CPT 27470: Repair of Femur Nonunion or Malunion Without Graft
CPT code 27470 represents surgical repair of nonunion or malunion of the femur below the head and neck without use of a graft. This operative code is central to orthopedic trauma and reconstructive practice because it documents definitive management of failed femoral fractures, which can reduce long-term disability and the need for repeat procedures. Nationally, correct coding for these complex reconstructive procedures affects coverage determinations, facility billing, and quality measurement.
Key payers included in this publication are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will gain an overview of clinical indications tied to 27470, typical sites of service, and the billing context for femoral nonunion and malunion repair. The analysis covers common payer approaches to surgical fracture repair coding, encounter settings where the code is used, and operational considerations for documenting surgical repair without grafting.
This piece provides benchmarks and policy-relevant points for providers, coders, and administrators: clinical context for appropriate use of 27470, how the code integrates into surgical service lines, and what national payers commonly consider when adjudicating these claims. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 27470 describes surgical repair of a femoral shaft nonunion or malunion below the femoral head and neck without use of a bone graft. The procedure addresses failed or improperly healed fractures of the femur diaphysis and proximal metaphysis through internal fixation and corrective techniques.
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Service type: Surgical orthopedics — fracture repair and reconstruction
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Typical site of service: Inpatient hospital or ambulatory surgical center depending on patient condition and surgical complexity
Clinical & Coding Specifications
Clinical Context
A 56-year-old patient presents with persistent thigh pain, limb shortening, and difficulty bearing weight six months after a high-energy femoral shaft fracture treated initially with intramedullary nailing. Radiographs and CT demonstrate a nonunion of the femoral diaphysis below the femoral head and neck with malalignment but without evidence of infection. The orthopedic surgeon plans an open repair of the nonunion/malunion of the femur (revision fixation) without use of bone grafting.
The clinical workflow includes preoperative evaluation (history, focused musculoskeletal exam, neurovascular assessment), imaging review (AP and lateral femur, CT if needed), anesthesia evaluation, consent for revision fixation, operative fixation (exposure of nonunion site, debridement of fibrous tissue, realignment, fixation with plates, screws or exchange of intramedullary device as indicated), intraoperative fluoroscopy to confirm alignment, wound closure, immediate postoperative radiographs, and routine postoperative follow-up with progressive weight-bearing as tolerated based on fixation stability. Typical site of service is an inpatient or outpatient hospital operating room or ambulatory surgery center depending on comorbidities and procedure complexity. The service type is surgical — open repair of femoral nonunion or malunion below the femoral head/neck without grafting, reported with 27470.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 |