Summary & Overview
CPT 27645: Tibial Tumor Resection with Wide Margins
CPT code 27645 denotes surgical resection of a tibial tumor with wide margins, a procedure used to treat severe chronic osteomyelitis and primary or metastatic bone malignancies. This code captures major orthopedic-oncologic work that often involves complex perioperative planning, possible reconstruction, and multidisciplinary care. Nationally, claims for this code reflect high-acuity surgical episodes with implications for hospital resource use, device and graft utilization, and post-acute care needs.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for when 27645 is reported, typical sites of service, and the kinds of benchmarks and policy considerations that affect coverage and payment for major limb-sparing or ablative tibial procedures.
The publication summarizes benchmarks such as utilization patterns, allowed amounts, and length-of-stay expectations where available, highlights relevant policy updates affecting surgical and hospital reimbursement, and outlines clinical context including indications and care settings. Data not provided in the input are noted as such; readers will gain a practical, national-level view of the code’s clinical role and payer landscape rather than state-specific guidance.
Billing Code Overview
CPT code 27645 describes the surgical removal of a tumor from the tibia with wide margins of normal tissue. The procedure is performed to treat severe chronic osteomyelitis or bone cancer affecting the tibia.
Service Type: Surgical excision / oncologic orthopedic surgery
Typical Site of Service: Inpatient or outpatient hospital surgical setting or ambulatory surgery center, depending on case complexity and need for reconstruction or extended postoperative care.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 52-year-old patient presents with chronic, refractory osteomyelitis of the tibia following multiple prior debridements and persistent draining sinus tracts. Imaging (radiographs and MRI) demonstrates osteolytic destructive changes and sequestra confined to the midshaft tibia. The patient has failed prolonged antibiotic therapy and requires definitive surgical management. The orthopedic oncology team schedules a wide excision of the involved tibial segment to remove necrotic and infected bone with oncologic margins when tumor is suspected.
Preoperative workflow includes history and physical, optimization of comorbid conditions (eg, diabetes control), preoperative imaging, and coordination with infectious disease for perioperative antibiotics. Intraoperatively, the surgeon performs a segmental tibial resection with wide margins, obtains bone and soft tissue cultures and pathology specimens, and may place spacers, perform immediate reconstruction (eg, bone graft, cement spacer, external fixation, or vascularized graft) or stage reconstruction depending on intraoperative findings. Postoperative workflow includes inpatient monitoring, targeted antibiotic therapy based on cultures, wound care, and staged reconstructive planning if required. Rehabilitation and weight-bearing restrictions are determined by the extent of resection and reconstruction.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | Use when the procedure is performed on the left tibia |
RT | Right side | Use when the procedure is performed on the right tibia |
50 | Bilateral procedure | Use if both tibiae are resected in the same operative session (rare) |
62 | Two surgeons | Use when two surgeons from different specialties perform distinct portions of the resection/reconstruction |
80 | Assistant surgeon | Use when a surgical assistant is documented and reimbursable under payer policies |
22 | Increased procedural services | Use when work required is substantially greater than typical (eg, unexpected extensive dissection, reconstruction) with documentation of reasons |
52 | Reduced services | Use when the procedure is partially reduced or not completed as planned (eg, aborted resection) |
53 | Discontinued procedure | Use when the procedure is terminated due to extenuating circumstances after anesthesia induction |
76 | Repeat procedure by same physician | Use when the same physician repeats the same procedure during the global period (note: 76 was not in provided list; not applicable) |
62 | Two surgeons | Data duplicate avoided by using only once |
| Modifier | Description | When to Use |
|---|---|---|
73 | Discontinued outpatient procedure prior to anesthesia | Use when an outpatient procedure is stopped prior to administration of anesthesia |
78 | Return to the operating room for a related procedure during the postoperative period | Use when the patient requires a related reoperation for complications during the global period |
79 | Unrelated procedure or service by the same physician during the postoperative period | Use when an unrelated procedure is performed during the global period (note: 79 not in provided list; not applicable) |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207L00000X | Orthopedic Surgery | Primary specialty performing tibial wide excision and reconstruction |
207P00000X | Orthopedic Surgery of the Lower Extremity | Subspecialty focus on lower extremity bone and joint surgery |
2080P0262X | Orthopedic Oncology | Surgeons specializing in tumor resections of long bones |
207K00000X | Vascular Surgery | Involved when vascularized grafts or microvascular reconstruction are required |
2088P0902X | Infectious Disease | Consults for perioperative management of chronic osteomyelitis |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
| Data not available in the input. | Data not available in the input. | Data not available in the input. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
11010 | Debridement of skin, subcutaneous tissue, muscle and fascia | May be used for soft-tissue debridement of overlying infected tissue prior to or during tibial resection |
22899 | Unlisted procedure, spine and vertebral column (example placeholder) | Not applicable to tibia; Data not available in the input. |
27646 | Resection, lesion of tibia; with extensive reconstruction | Performed when wide excision is followed by immediate complex reconstruction of the tibia (note: code should be selected per exact reconstruction performed) |
20680 | Removal of implant; deep (eg, requiring incision and drainage) | Used when hardware removal is required as part of managing chronic osteomyelitis before or during resection |
27122 | Resection, hemipelvectomy, etc. (example placeholder) | Data not applicable; Data not available in the input. |