Summary & Overview
CPT 27638: Tibia/Fibula Bone Cyst Excision with Allograft
CPT code 27638 represents surgical excision of a bone cyst or benign tumor from the tibia or fibula with application of an allograft. This procedure addresses symptomatic or potentially infective bony lesions in the lower leg and is performed primarily by orthopedic surgeons in hospital operating rooms or ambulatory surgery centers. The code is nationally relevant because it captures a distinct operative service involving lesion removal and biologic repair, which has implications for surgical quality measurement, billing specificity, and reimbursement policy for musculoskeletal and orthopedic oncology care.
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, a summary of payer coverage considerations, and benchmarks and coding guidance relevant to claim submission for this procedure. The publication also highlights common modifiers used with surgical CPT codes and notes when additional documentation may be required for complex cases. Information is presented to support coding accuracy, facilitate payer discussions, and clarify the clinical circumstances under which CPT code 27638 is reported.
Data not available in the input: associated taxonomies, ICD-10 diagnoses, and related codes.
Billing Code Overview
CPT code 27638 describes surgical removal of a bone cyst or benign tumor from the tibia or fibula with placement of an allograft. The procedure is performed to prevent infection and relieve pain associated with the lesion.
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Service type: Surgical excision with grafting (orthopedic oncology/orthopedic surgery)
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Typical site of service: Hospital operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 28-year-old male presents with progressive left anterior leg pain and intermittent swelling after a minor injury. Imaging (plain radiographs and MRI) demonstrates a well-circumscribed expansile lytic lesion within the proximal tibial metaphysis consistent with a benign bone cyst. The orthopedic oncologist elects to perform surgical excision of the lesion with curettage and placement of an allograft to reduce risk of pathologic fracture, prevent secondary infection, and relieve pain. The typical workflow includes preoperative imaging and labs, informed consent, general or regional anesthesia in an ambulatory surgical center or hospital operating room, intraoperative lesion excision and irrigation, packing the cavity with bone allograft, hemostasis, wound closure, postoperative recovery, and instructions for weight-bearing and outpatient follow-up. Typical site of service is an operating room in an ambulatory surgical center or hospital. Service type is surgical — removal of benign bone lesion with allograft augmentation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
51 | Multiple Procedures | Use when more than one distinct procedure is performed during the same operative session in addition to the primary service. |
52 |