Summary & Overview
CPT 27524: Open Reduction Internal Fixation of Patellar Fracture with Patellectomy and Soft Tissue Repair
CPT code 27524 represents an open reduction and internal fixation (ORIF) procedure for patellar fractures that may include partial or complete excision of the patella and repair of surrounding soft tissues. This operative orthopedic code is used when the goal is restoration of patellar stability and optimization of healing after displaced or comminuted fractures. Nationally, accurate coding for this procedure affects surgical quality measurement, reimbursement pathways, and post-operative care planning.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical indications tied to surgical management of patellar fractures, common sites of service, and the typical service context for billing. The publication also outlines benchmarking and coverage considerations relevant to these major payers, operational coding guidance, and recent policy updates that influence prior authorization and facility reimbursement practices.
This summary equips clinicians, coding professionals, and policy analysts with concise context on when and how CPT code 27524 is applied, what to expect from payer coverage patterns, and where to locate detailed benchmarks and policy notes for national practice settings.
Billing Code Overview
CPT code 27524 describes an open reduction and internal fixation (ORIF) of a patellar fracture with partial or complete excision of the patella and soft tissue repair. The procedure is performed to restore patellar alignment, stabilize the extensor mechanism, and promote fracture healing.
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Service type: Operative orthopedic procedure involving fracture fixation and soft tissue reconstruction
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Typical site of service: Hospital operating room or ambulatory surgical center
Clinical & Coding Specifications
Clinical Context
A typical patient is a 45-year-old adult who sustained a comminuted patellar fracture after a fall from standing or a direct blow to the knee. The patient presents to the emergency department with anterior knee pain, swelling, inability to actively extend the knee, and an obvious deformity on exam. Radiographs (AP, lateral, and sunrise views) confirm a displaced or comminuted fracture of the patella with loss of extensor mechanism continuity. After initial immobilization, analgesia, and medical clearance, the patient is taken to the operating room for an open reduction and internal fixation with possible partial or complete patellectomy and soft tissue repair to restore patellar stability and the extensor mechanism.
Preoperative workflow includes history and physical, informed consent documenting risks/benefits of open reduction and possible patellar excision, review of imaging, and anesthesia evaluation. Intraoperative steps typically include exposure of the patella, evacuation of hematoma, debridement of fracture edges, fixation with tension band wiring, screws, or fragment excision if non-reconstructable, and repair of retinacular/soft tissue structures. Postoperative workflow includes neurovascular checks, immobilization or hinged knee brace, pain control, DVT prophylaxis per protocol, early range-of-motion progression as tolerated, and outpatient orthopedic follow-up with repeat radiographs to confirm healing and patellar stability.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services |