Summary & Overview
CPT 27598: Lower Leg Disarticulation Preserving Femoral End
CPT code 27598 denotes a surgical lower-extremity disarticulation in which the tibia and fibula are separated from the femur without bone cutting, enabling removal of the lower leg while preserving the distal femoral end for partial weight bearing. This procedure has clinical importance for limb salvage decisions, prosthetic planning, and postoperative rehabilitation, and it has cost and coverage implications across national payer markets. Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical description, the typical settings where the service is delivered, commonly reported billing modifiers, and an overview of payer coverage considerations and benchmarking where available. The publication outlines how CPT code 27598 is used in clinical documentation, the procedural context for orthopedic and vascular surgical teams, and operational factors affecting hospital and ambulatory surgical center billing. Data not available in the input is noted where benchmarks, associated taxonomies, and specific ICD-10 mappings would otherwise be discussed.
Billing Code Overview
CPT code 27598 describes a surgical procedure to separate the tibia and fibula of the lower leg from the femur without cutting bones, allowing removal of the lower leg while preserving the femoral end so the patient can bear some weight on the residual limb. This procedure is a form of lower extremity amputation performed at the level of the distal femur.
-
Service type: Surgical amputation of the lower leg with preservation of femoral bone end (closed disarticulation/through-knee–type approach)
-
Typical site of service: Operating room or surgical suite in an acute care hospital or ambulatory surgical center where major limb amputation procedures are performed
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a non-salvageable lower leg after severe trauma (e.g., mangling crush injury, ischemic necrosis, or severe infection) or chronic limb-threatening conditions where limb preservation is not possible. The patient presents with uncontrolled pain, nonviable distal tissue, or prosthetic and functional considerations favoring an above-knee amputation that spares cutting the femur.
Preoperative workflow includes multidisciplinary evaluation (trauma or vascular surgery, orthopedics, anesthesia, rehabilitation and prosthetics consultation), informed consent discussing weight-bearing and prosthetic outcomes, preoperative imaging as needed, and optimization of comorbidities. In the operating room under general or regional anesthesia, the surgeon performs a knee disarticulation (surgical separation of the tibia and fibula from the femur) preserving the femoral length and soft tissue envelope to allow partial weight bearing on the femoral condyles. Postoperative care includes pain control, wound monitoring, early mobilization, physical therapy, and coordination with prosthetics and home health as indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | When the procedure is performed on the left leg. |
RT |