Summary & Overview
CPT 27535: ORIF of Unicondylar Proximal Tibial Plateau Fracture
CPT code 27535 denotes open reduction and internal fixation (ORIF) of a unicondylar proximal tibial plateau fracture, a targeted orthopedic procedure to restore articular alignment and knee stability after focal tibial plateau injury. This surgical code matters nationally because tibial plateau fractures can compromise knee function and often require operative fixation to prevent long-term disability and osteoarthritis. Claims for this procedure drive hospital and surgeon resource use in orthopedic trauma and joint reconstruction pathways.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for CPT code 27535, typical sites of service, and the procedural goals. The publication summarizes benchmark considerations used by major payers and Medicare, highlights common billing modifiers associated with surgical services, and outlines coding considerations relevant to operative management of unicondylar tibial plateau fractures.
The piece is intended to inform coding specialists, revenue cycle managers, and policy analysts about the clinical intent and billing context of CPT code 27535, what to expect in payer coverage frameworks, and where to look for further documentation and claim validation requirements.
Billing Code Overview
CPT code 27535 describes open reduction and internal fixation of a unicondylar proximal tibial plateau fracture. The procedure involves surgical exposure of the fracture site, realignment of bone fragments, and stabilization with internal fixation devices to restore joint surface congruity and limb alignment.
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Service type: Surgical orthopedic procedure
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Typical site of service: Inpatient or outpatient hospital operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 46-year-old male presents after a fall from a ladder onto his right knee with immediate pain, swelling, and inability to bear weight. Radiographs and CT confirm an isolated unicondylar lateral proximal tibial plateau fracture with mild displacement and joint depression. The orthopedic trauma surgeon discusses treatment options and schedules an open reduction and internal fixation using plate and screw fixation to restore articular congruity and limb alignment.
Preoperative workflow includes history and physical, informed consent, anesthesia evaluation (general or regional), preoperative imaging review, and surgical planning for reduction and fixation. Intraoperative steps include exposure of the tibial plateau, reduction of the unicondylar fragment, provisional fixation, definitive plate and screw fixation, intraoperative fluoroscopy to confirm alignment, irrigation and closure. Postoperative care includes pain control, DVT prophylaxis, wound checks, radiographs to confirm fixation, and a graduated weight-bearing plan with physical therapy.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, and effort substantially exceed typical for 27535 (documentation required). |