Summary & Overview
CPT 27538: Closed Reduction of Intercondylar Spine or Tuberosity Knee Fracture
CPT code 27538 denotes a closed reduction of an intercondylar spine or tuberosity fracture of the knee, a common orthopedic procedure to realign and stabilize fracture fragments without open surgical exposure. This code is important nationally because timely, appropriate closed reduction can affect short-term pain, immediate joint stability and longer-term functional outcomes, and it is frequently billed across hospital, ambulatory surgical center and emergency settings.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare. Readers will find a concise explanation of the code and clinical context, typical sites of service, and the common billing modifiers associated with procedural adjustments. The publication also provides benchmark and coverage considerations relevant to national payer policies, along with coding relationships that inform claim adjudication and documentation expectations.
This resource is intended for billing professionals, orthopedic clinicians, and policy analysts seeking a clear, national-level summary of CPT code 27538, including practical coding context and the elements that influence payer review and payment decisions.
Billing Code Overview
CPT code 27538 describes a closed reduction of a fracture of the intercondylar spine or tuberosity of the knee, performed with or without manipulation. The procedure is intended to align and maintain fractured bone fragments so that normal healing can occur.
Service type: Orthopedic fracture management, closed reduction
Typical site of service: Hospital inpatient or outpatient surgical setting, ambulatory surgery center, or emergency department
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 42-year-old male presents to the emergency department after a fall from a ladder with acute right knee pain, swelling, and inability to bear weight. Imaging (AP/lateral radiographs and CT) demonstrates a displaced avulsion fracture of the tibial intercondylar eminence (intercondylar spine). The orthopedic surgeon performs a closed reduction with or without gentle manipulation under procedural sedation in the operating room or procedural suite to realign the fractured fragment and restore knee stability. The procedure aims to obtain acceptable fragment position to permit healing and preserve anterior cruciate ligament attachment. Post-reduction fluoroscopic images confirm fragment alignment. The patient is placed in a knee immobilizer or hinged knee brace with weight-bearing restrictions and scheduled for short-interval follow-up with repeat radiographs and physical therapy as indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier required / not used (placeholder) | Rarely used; present in input list but not typically appended to claims |
11 | Office or other outpatient visit for evaluation and management services | When an unrelated E/M service is separately reported on the same day by the same provider and payer rules allow |