Summary & Overview
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.
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.
Clinical & Coding Specifications
Clinical Context
A 46-year-old male presents to the emergency department after a high-energy motor vehicle collision with severe right distal femur pain, swelling, and inability to bear weight. Radiographs and CT demonstrate a displaced supracondylar and intercondylar femoral fracture extending into the knee joint. After orthopaedic trauma evaluation, the patient is scheduled for operative management: open reduction and internal fixation to anatomically reduce the articular surface and stabilize the distal femur using plates and screws. The patient is admitted to an inpatient surgical service. Preoperative steps include informed consent, medical optimization, pre-op labs, and anesthesia evaluation. In the operating room under general or regional anesthesia, the orthopaedic surgeon performs an open exposure of the distal femur, reduces the fracture fragments, and secures fixation with internal hardware (locking plate and screws). Intraoperative fluoroscopy is used to confirm alignment and hardware placement. Postoperative workflow includes analgesia, neurovascular checks, DVT prophylaxis, imaging to confirm reduction, weight-bearing status instructions, physical therapy initiation, and discharge planning with outpatient follow-up for wound checks and progressive rehabilitation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use for substantially greater work, time, or complexity than typical for the procedure when well-documented. |
23 | Unusual anesthesia | Use when general anesthesia is required for a procedure usually performed with local/regional anesthesia and documentation supports it. |
26 | Professional component | Use if billing only the surgeon's professional component separate from technical charges. |
50 | Bilateral procedure | Use when the same open reduction and internal fixation is performed on both femurs during the same operative session. |
51 | Multiple procedures | Use when additional distinct procedures are performed in the same operative session (distinct from bundled fracture fixation). |
52 | Reduced services | Use when the procedure is partially reduced or not completed as planned with supporting documentation. |
53 | Discontinued procedure | Use when the operative procedure is started but terminated for reasons beyond the surgeon's control. |
59 | Distinct procedural service | Use to indicate a separate and distinct procedure or service not normally reported together, when supported by operative note. |
62 | Two surgeons | Use when two surgeons of different specialties work together as primary surgeons performing distinct parts of the procedure. |
66 | Surgical team | Use when a surgical team performs complex trauma procedures requiring multiple surgeons. |
78 | Return to OR for related procedure during postoperative period | Use for unplanned return to the operating room for a related procedure during the global period. |
79 | Unrelated procedure or service during postoperative period | Use when an unrelated procedure is performed during the global period. |
LT | Left side | Use to denote the left femur procedure when laterality is required. |
RT | Right side | Use to denote the right femur procedure when laterality is required. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207X00000X | Orthopaedic Surgery | Primary specialty performing open reduction and internal fixation of distal femur fractures. |
| 208000000X | Orthopaedic Trauma | Subspecialty focus on complex fracture care and perioperative trauma management. |
| 208600000X | General Surgery | May be involved in polytrauma or multidisciplinary abdominal/thoracic management when required. |
| 207L00000X | Sports Medicine (Orthopaedic) | May manage periarticular fractures and postoperative rehabilitation in elective trauma cases. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
S72.451A | Displaced fracture of lower end of right femur, initial encounter for closed fracture | Typical diagnosis for a displaced distal femur fracture requiring open reduction and internal fixation. |
S72.452A | Displaced fracture of lower end of left femur, initial encounter for closed fracture | Left-sided equivalent for coding laterality when left distal femur is injured. |
S72.441A | Nondisplaced fracture of lower end of right femur, initial encounter for closed fracture | Nondisplaced fractures may still require ORIF if articular involvement or instability exists. |
S72.451B | Displaced fracture of lower end of right femur, initial encounter for open fracture | Open fractures with soft tissue injury often require ORIF plus irrigation and debridement and possible staged procedures. |
M84.361A | Pathological fracture, right femur, initial encounter for fracture | Pathologic fractures through weakened bone may necessitate internal fixation with special considerations. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
20690 | Application of external fixation device (initial), includes pin or wire placement | Used prior to definitive ORIF for initial stabilization of severely comminuted or open distal femur fractures or as temporary stabilization in polytrauma. |
27511 | Open treatment of distal femoral fracture, with or without internal fixation, medial or lateral condyle (separate) | Related variant for distal femur fractures that may describe fixation of a single condylar fragment; may be used when fracture is limited to one condyle. |
27514 | Open treatment of supracondylar femoral fracture with internal fixation, proximal to condyles (includes plates/screws) | Used for fractures in a nearby anatomic region; helps distinguish level of fracture for correct coding when fracture extends above condyles. |
20680 | Removal of implanted material, deep (e.g., plates, screws), requiring major incision | Performed if hardware removal is necessary later for infection, pain, or nonunion. |
73562 | Radiologic examination, femur, minimum two views | Preoperative and postoperative imaging to document fracture and hardware position; used in perioperative workflow. |
73600 | Radiologic examination, ankle, complete, minimum two views | Data not available in the input. |