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CPT 27513: Open Reduction, Distal Femur Intercondylar Fracture
CPT code 27513 represents an open reduction of a distal femur fracture that extends across the condyles into the intercondylar space, commonly performed with internal fixation hardware to restore alignment and joint stability. This code is used for surgical management of complex femoral condylar fractures and is clinically significant due to its implications for functional recovery, postoperative rehabilitation, and resource use in orthopedics.
Key payers addressed in national coverage and claims discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical intent and coding context, reimbursement and utilization benchmarks where available, common billing modifiers, and considerations for claims submission and post-operative care coordination. The publication outlines typical sites of service and the procedural components that support correct coding. It also highlights common billing challenges for complex orthopedic fracture repairs and summarizes the types of documentation payers commonly request. Data not available in the input is noted where applicable.
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Billing Code Overview
CPT code 27513 describes an open reduction of a femoral fracture that involves the distal femur and extends into the intercondylar region, typically requiring internal fixation with hardware such as plates, screws, nails, or wires to restore alignment and stability. The procedure focuses on anatomical reduction of the femoral condyles and stabilization to promote early bone healing and restore knee joint function.
Service Type: Open surgical fracture repair (orthopedic trauma surgery)
Typical Site of Service: Inpatient hospital operating room or ambulatory surgical center for complex cases, depending on patient condition and surgical complexity.