Summary & Overview
CPT 27540: ORIF of Intercondylar Spine or Tuberosity of Knee
CPT code 27540 denotes open reduction and internal fixation (ORIF) of fractures of the intercondylar spine or tuberosity of the knee. This surgical code captures definitive operative management intended to restore anatomic alignment and stability of intra-articular knee fracture fragments — a procedure with implications for functional outcomes, postoperative rehabilitation, and resource use across inpatient and ambulatory surgical settings.
Key payers typically involved in coverage decisions for this procedure include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers of this publication will find a concise clinical context for the code, national coverage considerations across major payers, and operational benchmarks that inform coding practice and revenue-cycle workflows. The analysis covers common service settings, documentation elements that support medical necessity, and how this code fits within surgical management pathways for knee fractures.
This summary is intended for clinicians, billing professionals, and policy analysts seeking a national overview of the code’s clinical role, payer mix, and areas to consider for documentation and workflow alignment. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 27540 describes an open reduction and internal fixation procedure for a fracture of the intercondylar spine or tuberosity of the knee. The procedure involves surgically exposing the fracture site, realigning the fractured fragments, and using internal fixation devices (such as screws, plates, or wires) to maintain proper alignment for healing.
Service Type: Surgical — Orthopedic fracture repair
Typical Site of Service: Hospital operating room or outpatient/ambulatory surgical center
Clinical & Coding Specifications
Clinical Context
A 42-year-old male presents to the emergency department after a bicycle-versus-automobile collision with acute right knee pain, swelling, and inability to bear weight. Radiographs and CT confirm a displaced intercondylar tibial spine fracture with articular involvement and fragment displacement compromising joint congruity. After initial splinting, neurovascular assessment, and informed consent, the patient is taken to the operating room for open reduction and internal fixation of the tibial intercondylar spine. General or regional anesthesia is provided; the surgeon performs an open incision, exposes the fracture, reduces the fragment to restore articular alignment, and secures fixation with screws and/or small plates. Postoperative care includes immobilization in a knee brace, pain control, DVT prophylaxis as indicated, and early planned physical therapy for range of motion once fixation is stable. Typical workflow includes pre-op templating and imaging, intraoperative fluoroscopic verification of reduction, operative documentation of approach and fixation devices, and detailed post-op instructions for weight-bearing status and follow-up imaging.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, or intensity substantially exceeds typical for open reduction and internal fixation of tibial intercondylar spine. |