Summary & Overview

CPT 27472: Repair of Femur Nonunion or Malunion with Bone Graft

CPT code 27472 denotes surgical repair of a femoral shaft nonunion or malunion below the femoral head and neck that includes harvesting and implantation of an autologous bone graft. This code captures a complex orthopedic reconstructive procedure that has implications for operative time, resource utilization, and post-operative care pathways. Nationally, effective coding of these procedures supports accurate payment, quality measurement, and tracking of complication and reoperation rates.

Key payers referenced include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a compact executive overview of clinical intent, typical settings of care, and the major payer landscape covered in the publication.

The full analysis provides benchmarks and utilization patterns, coding and documentation considerations tied to procedural components (repair plus graft harvest), and clinical context including expected surgical setting and service type. The content is intended to help coding managers, practice administrators, and policy analysts understand how CPT code 27472 is used across payers and what items of clinical documentation and claim construction are most relevant. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare27472CPTorthopedicsfemur fracture repairbone graftsurgical procedurereconstructive surgeryoperative coding

Billing Code Overview

CPT code 27472 describes an operative procedure to repair a nonunion or malunion of a femur fracture located below the femoral head and neck. The procedure includes harvesting an autologous bone graft (commonly from the iliac crest or another donor site on the same patient) and using that graft to reinforce the femoral repair.

Service Type: Open fracture repair with bone grafting / orthopedic reconstructive surgery

Typical Site of Service: Inpatient or outpatient hospital operating room; specialized ambulatory surgery center

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 62-year-old male presents with persistent lateral thigh pain and difficulty ambulating nine months after a displaced mid-shaft femoral fracture treated initially with intramedullary nailing at an outside hospital. Serial radiographs and CT show failure of fracture healing with a symptomatic nonunion distal to the femoral head and neck. The orthopedic trauma surgeon schedules an operative revision: open repair of the femoral nonunion with debridement of fibrous tissue, revision fixation and structural and/or cancellous autogenous bone graft harvested from the iliac crest to promote union. The typical clinical workflow includes preoperative optimization (medical clearance, imaging, and surgical consent), intraoperative procedure (exposure of the nonunion, removal or revision of hardware as needed, decortication, fixation revision, iliac crest bone graft harvest and placement), and postoperative care (pain control, weight-bearing restrictions, infection surveillance, and radiographic follow-up). Typical site of service is an inpatient or outpatient hospital operating room or ambulatory surgery center for complex reconstructive fixation depending on patient comorbidities and anesthesia needs.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when documented work, time, or complexity substantially exceeds typical for `27472`.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons during the same operative session.
`80`	Assistant surgeon	Use when a qualified assistant surgeon provides assistance (non-physician assistants use different modifiers).
`81`	Minimum assistant surgeon	Use when a minimal assistant surgeon is documented.
`82`	Assistant surgeon (when qualified resident not available)	Use when a qualified resident is not available and an assistant is necessary.
`50`	Bilateral procedure	Use if bilateral femoral nonunions are repaired during the same operative session (rare for `27472`).
`53`	Discontinued procedure	Use if the procedure is started but discontinued for patient safety reasons.
`55`	Postoperative management only	Use if only postoperative care is billed separately from the operative service.
`58`	Staged or related procedure or service by the same physician during the postoperative period	Use when the definitive repair is planned as a staged procedure following an initial procedure.
`76`	Repeat procedure by same physician (Note: not in provided list)	Data not available in the input.
`LT`	Left side	Use to indicate the left femur when laterality is required.
`RT`	Right side	Use to indicate the right femur when laterality is required.
`61`	Data not available in the input	Data not available in the input.

Taxonomy Code	Specialty	Notes
`207W00000X`	Orthopaedic Surgery	Primary specialty performing femoral nonunion repair and bone grafting.
`2080P0207X`	Orthopedic Trauma	Subspecialty focused on fracture nonunions and complex revision fixation.
`207L00000X`	Surgery - General	May be involved in multi-disciplinary cases or smaller centers.
`207K00000X`	Surgical Oncology	Occasionally involved if tumor-related reconstruction overlapped (rare).

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M84.151A`	Pathological fracture, right femur, initial encounter for fracture	Applicable when nonunion involves a pathological fracture of the right femur; may affect healing and grafting decisions.
`M84.152A`	Pathological fracture, left femur, initial encounter for fracture	Applicable for left femoral pathological fractures requiring nonunion repair.
`M84.151D`	Pathological fracture, right femur, subsequent encounter	Used for follow-up encounters related to previously diagnosed pathological fracture/nonunion.
`M84.152D`	Pathological fracture, left femur, subsequent encounter	Used for follow-up encounters related to left femoral nonunion.
`M84.371A`	Stress fracture, right femur, initial encounter	Stress fractures that progressed to nonunion may be a reason for `27472`.
`M84.372A`	Stress fracture, left femur, initial encounter	Left-sided stress fracture leading to nonunion repair.
`M84.49XA`	Nonunion of fracture of other specified bone, initial encounter	General nonunion code that can apply when laterality or more specific femur code is not used.
`S72.201A`	Unspecified fracture of shaft of right femur, initial encounter for closed fracture	Fracture codes for femoral shaft fractures that may later develop nonunion and require `27472`.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`27472`	Repair, nonunion or malunion, femur, below head and neck; with bone graft (includes obtaining graft)	Primary procedure — open repair of femoral nonunion with autogenous bone graft harvest and placement.
`20930`	Allograft, morselized, or placement of osteopromotive material, for spine, long bone, or pelvis; per graft	May be used if additional allograft or osteoinductive materials are implanted alongside autograft.
`20936`	Autograft, tibia or fibula, structural, includes obtaining graft	Used if a structural autograft from another site (tibia/fibula) is used instead of iliac crest.
`11010`	Debridement of open fracture wound, includes removal of foreign material and irrigation; simple, for open fractures	May be performed if the nonunion site requires formal debridement prior to definitive fixation (concurrent or prior).
`20680`	Removal of deep implant (e.g., nail)	Performed when previous internal fixation hardware is removed as part of the nonunion repair.
`27075`	Open treatment of proximal femoral fracture, includes internal fixation, with or without bone graft	Related proximal femur fixation procedures that may be used depending on nonunion location and technique.