Summary & Overview
CPT 27592: Complete Femoral Transection to Control Limb Infection
CPT code 27592 represents a major orthopedic surgical procedure involving complete circumferential transection of the femur to control severe limb infection. The procedure is clinically significant because it is performed when conservative and limb-sparing interventions are insufficient to manage life- or limb-threatening infection. Nationally, this code is relevant for acute inpatient surgical care, surgical quality reporting, and high-acuity billing scenarios.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and typical sites of service, followed by benchmarking and coverage considerations where available. The publication highlights coding context for hospital and operating-room settings, common modifiers used with high-acuity surgical CPT codes, and how payers commonly approach authorization and reimbursement for major limb surgery. It also outlines where additional documentation and clinical justification are typically required.
The material is organized to help coding professionals, hospital billing teams, and policy analysts understand clinical intent, common billing scenarios, and payer relationships relevant to CPT code 27592. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 27592 describes a surgical procedure in which the provider performs a complete circumferential cut through the femur at any location along the thigh. The procedure is intended to control severe infection in a limb by creating a through-and-through transection of the femur.
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Service type: Major orthopedic surgical procedure for limb infection control
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Typical site of service: Operating room or inpatient surgical setting
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a limb-threatening, deep femoral infection (for example, necrotizing soft tissue infection, uncontrolled osteomyelitis of the femur, or severe ischemic limb with superimposed infection) who has failed aggressive medical therapy including intravenous antibiotics, repeated debridement, and revascularization attempts. The patient often presents with systemic signs of sepsis, persistent purulence, foul odor, and nonviable tissue of the thigh despite prior interventions. Initial workflow includes emergency department triage, hemodynamic stabilization, broad-spectrum IV antibiotics, imaging (radiographs, CT, or MRI) to assess bone involvement and soft tissue extent, and consultation with orthopedics, vascular surgery, and infectious disease. When limb salvage is not possible and infection threatens life, the surgical team obtains informed consent and prepares for an open femoral-level guillotine amputation under general or regional anesthesia. Perioperative steps include antibiotic redosing, tourniquet or vascular control as indicated, sterile prep, circular guillotine-level transection through soft tissue and femur with the objective of removing the infected segment, intraoperative cultures, and gross debridement. Postoperative care includes wound management, possible conversion to staged definitive amputation (flap closure or myodesis) once infection is controlled, occupational/physical therapy planning, prosthetic referral, and infectious disease-directed antimicrobial therapy based on cultures.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT |