Summary & Overview
CPT 27720: Repair of Tibial Nonunion or Malunion Without Graft
CPT code 27720 denotes surgical repair of a malunited or nonunited tibial fracture without the use of a bone graft. Nationally, this code captures definitive orthopedic interventions intended to restore function and reduce pain in patients whose tibial fractures have healed improperly or failed to heal. The procedure is clinically significant due to its role in preventing long-term disability and enabling return to activity.
Key payers in the assessment include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical indications, usual sites of service, and common billing considerations tied to this procedure. The publication outlines benchmark elements and payer coverage context relevant at the national level, along with operational implications for hospital and ambulatory surgical settings.
This report provides clinicians, coders, and administrators with concise context on code usage, expected clinical scenarios, and what to consider when documenting a repair of tibial nonunion or malunion performed without grafting. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 27720 describes the surgical repair of a malunited or nonunited fracture of the tibia without the use of a bone graft. The procedure is performed to restore limb function and relieve pain after a tibial fracture has healed improperly or failed to heal.
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Service type: Surgical orthopedic procedure for fracture management
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Typical site of service: Inpatient or outpatient hospital surgical setting, or ambulatory surgery center when clinically appropriate
Clinical & Coding Specifications
Clinical Context
A 42-year-old male presents with persistent tibial pain, malalignment, and impaired ambulation nine months after a midshaft tibial fracture initially treated nonoperatively with casting. Imaging demonstrates a malunited tibial shaft fracture with angular deformity and focal cortical irregularity without evidence of osseous infection. The orthopaedic surgeon schedules an open osteotomy and internal fixation to correct the malunion and restore alignment and function. The procedure performed is coded as 27720, defined as repair of a tibial fracture that has healed improperly or not at all, without placement of graft. Typical workflow includes preoperative evaluation in the orthopaedic clinic, surgical consent with discussion of risks/benefits, preoperative imaging review (radiographs and possible CT), pre-op anesthesia evaluation, operative osteotomy with realignment and internal fixation (plates and screws or intramedullary nail as appropriate), intraoperative fluoroscopic imaging, postoperative recovery, and inpatient or outpatient follow-up for wound checks and radiographic healing assessment. Typical site of service is an inpatient or outpatient hospital operating room or ambulatory surgery center depending on patient comorbidities and expected length of stay. The service type is surgical/orthopaedic reconstructive procedure to restore function and relieve pain from a malunited or nonunited tibial fracture.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component |