Summary & Overview
CPT 27640: Partial Tibial Ostectomy for Osteomyelitis Debridement
CPT code 27640 describes a surgical partial ostectomy or saucerization of the tibia to remove diseased bone for the treatment of osteomyelitis. This procedure is clinically significant because effective surgical debridement can be essential to eradicate deep bone infection, limit spread, and support limb salvage. Nationally, coding and coverage for such operative management affect hospital and surgical practice workflows, utilization tracking, and quality measurement.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find concise information on the clinical intent of the code, typical sites of service, and how the code is positioned in billing workflows. The publication outlines common modifiers and payer considerations where available, presents benchmark and utilization context when applicable, and summarizes relevant clinical context for osteomyelitis management.
The content is organized to help coding managers, surgical providers, and revenue cycle staff quickly understand what CPT code 27640 represents, where it is typically reported, and which payers are central to national coverage and claims processing. Data not provided in the input (such as specific reimbursement rates, ICD-10 pairings, or payer-specific policy text) is noted as unavailable in the relevant sections.
Billing Code Overview
CPT code 27640 describes a surgical procedure to remove a portion of diseased tibial bone to treat osteomyelitis. The provider removes the central or affected section of the tibia or scoops out infected bone, leaving a saucer-like or crater-like depression.
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Service type: Surgical debridement/partial ostectomy of the tibia for infection management
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Typical site of service: Operative setting such as an ambulatory surgery center or inpatient/outpatient hospital operating room
Clinical & Coding Specifications
Clinical Context
A 58-year-old male with poorly controlled diabetes and peripheral vascular disease presents with chronic draining sinus and persistent localized pain of the distal tibia despite prolonged antibiotics and debridement. Imaging (radiographs and MRI) demonstrates focal cortical and medullary destruction consistent with chronic tibial osteomyelitis localized to a defined segment of the tibial shaft. The orthopedic surgeon schedules an operative saucerization of the tibia to remove the diseased bone and obtain cultures, performed in an operating room under general or regional anesthesia. Intraoperative workflow includes preoperative antibiotics per hospital protocol, orientation and marking of the affected tibial segment, incision and soft-tissue debridement, saucerization or cortical windowing of the tibia to remove necrotic bone, collection of specimens for microbiology and pathology, irrigation, possible placement of local antibiotic carriers (beads or cement), and layered wound closure or staged wound management. Postoperative care includes wound checks, culture-directed antibiotic therapy, activity restrictions, and follow-up imaging to assess bone healing and infection control. Typical site of service is the inpatient operating room or ambulatory surgery center depending on clinical status and complexity.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | When work, time, or intensity substantially exceeds usual for (document justification). |