CPT 27758 Tibial Shaft ORIF Reimbursement | OpenPayer

Summary & Overview

CPT 27758: Tibial Shaft Fracture Repair with Plate and Screw Fixation

CPT code 27758 represents open reduction and internal fixation (ORIF) of tibial shaft fractures using plates and screws, with optional wiring. This surgical code is used nationally to document definitive operative management intended to restore alignment, prevent displacement, and relieve pain during fracture healing. It is relevant across hospital inpatient and outpatient surgical settings and is commonly billed by orthopedic trauma and reconstructive surgeons.

Key payers in practice for this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical and billing overview, payer coverage context, and benchmarks typically considered when evaluating utilization and payment for operative tibial shaft fracture care. The publication outlines coding intent, typical sites of service, common clinical scenarios where the code applies, and related considerations for claims and reimbursement.

The analysis is designed to inform coding professionals, revenue cycle staff, and clinical managers about the clinical purpose and billing scope of CPT code 27758, spotlighting the procedural definition, how the code is used in practice, and the payer landscape that shapes coverage and payment patterns nationally.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare27758CPTtibial shaft fractureORIForthopedic surgeryfracture fixationambulatory surgeryinpatient surgery

Billing Code Overview

CPT code 27758 describes surgical repair of a tibial shaft fracture with internal fixation using plates and screws, with optional cerclage wiring. The procedure is performed to restore and maintain alignment of the tibial shaft, prevent displacement during healing, and relieve pain. A concurrent fibular fracture may be present but is not treated separately under this code.

Service type: Open reduction and internal fixation (ORIF) of tibial shaft fracture with plate and screw fixation

Typical site of service: Hospital operating room or ambulatory surgery center, performed by an orthopedic surgeon under surgical anesthesia.

Clinical & Coding Specifications

Clinical Context

A 38-year-old male presents to the emergency department after a motorcycle collision with acute pain, deformity, and inability to bear weight on the lower leg. Radiographs and CT confirm a displaced midshaft tibial fracture with mild comminution; a non-displaced fibular fracture is noted but not separately treated. The orthopedic trauma surgeon schedules the patient for open reduction and internal fixation (ORIF) of the tibial shaft using plates and screws (CPT 27758) under general anesthesia. Preoperative workflow includes informed consent, neurovascular exam documentation, pre-op imaging review, and prophylactic antibiotics. Intraoperative steps include exposure of the tibial shaft, reduction of the fracture, fixation with plate and screws (with optional cerclage wiring if needed), intraoperative fluoroscopy to confirm alignment and hardware position, and layered wound closure. Postoperative workflow includes immediate neurovascular checks, pain control, DVT prophylaxis, instructions on weight-bearing status (often restricted initially), scheduling outpatient follow-up with radiographs for healing assessment, and documentation of operative findings and implants in the operative report.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when intraoperative complexity or prolonged operative time significantly exceeds usual for and is documented.

CPT 27767: Posterior Malleolus Fracture Stabilization

CPT-27829-DISTAL-TIBIOFIBULAR-LIGAMENT-REPAIR-WITH-FIXATION

CPT 27829: Repair of Tibiofibular Ligaments with Tibia–Fibula Fixation

CPT-27842-CLOSED-TREATMENT-ANKLE-DISLOCATION-ANESTHESIA

CPT 27842: Closed Treatment of Ankle Dislocation with Anesthesia

CPT-27769-POSTERIOR-MALLEOLUS-OPEN-REPAIR-WITH-FIXATION

CPT 27769: Open Repair of Posterior Malleolus Fracture with Fixation

CPT-27818-CLOSED-TRIMALLEOLAR-ANKLE-FRACTURE-CLOSED-TREATMENT

CPT 27818: Closed Trimalleolar Ankle Fracture, Non‑operative Treatment

CPT-27823-TRIMALLEOLAR-ANKLE-FIXATION-ORIF

CPT 27823: Trimalleolar Ankle Fixation (ORIF)

CPT-27808-CLOSED-FIXATION-TWO-MALLEOLI-ANKLE

CPT 27808: Closed Fixation of Two Ankle Malleoli

CPT-27792-DISTAL-FIBULA-FRACTURE-FIXATION-OPEN-REDUCTION-INTERNAL-FIXATION

CPT 27792: ORIF of Distal Fibula Fracture

CPT-27814-BIMALLEOLAR-ANKLE-FRACTURE-FIXATION-OPEN-REDUCTION-INTERNAL-FIXATION

CPT 27814: Open Reduction and Internal Fixation of Two Malleoli

CPT-27828-DISTAL-TIBIA-ARTICULAR-SURFACE-FIXATION-ORIF

CPT 27828: Distal Tibia Articular Surface Fracture Fixation, ORIF

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CPT 27758

Taxonomy Code	Specialty	Notes
207X00000X	Orthopaedic Surgery	Primary specialty performing tibial shaft ORIF.
2080S0122X	Orthopedic Trauma Surgery	Subspecialty focusing on complex fracture care and plate fixation.
208000000X	Surgery	General surgeons may occasionally perform in austere settings but less common.
363A00000X	Anesthesiology	Provides general or regional anesthesia for the procedure.
207L00000X	Podiatric Surgery	Foot and ankle surgeons may perform fixation when tibial fractures involve distal tibia adjacent to ankle (less common).

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S82.201A`	Unspecified fracture of shaft of tibia, right leg, initial encounter for closed fracture	Common primary diagnosis for tibial shaft ORIF on the right side.
`S82.202A`	Unspecified fracture of shaft of tibia, left leg, initial encounter for closed fracture	Common primary diagnosis for tibial shaft ORIF on the left side.
`S82.221A`	Displaced transverse fracture of shaft of tibia, right leg, initial encounter for closed fracture	Specifies displaced tibial shaft fracture often requiring ORIF with plate and screws.
`S82.222A`	Displaced transverse fracture of shaft of tibia, left leg, initial encounter for closed fracture	Left-sided counterpart indicating fixation need.
`S82.231A`	Displaced oblique fracture of shaft of tibia, right leg, initial encounter for closed fracture	Oblique fractures frequently stabilized with plating.
`S82.241A`	Displaced spiral fracture of shaft of tibia, right leg, initial encounter for closed fracture	Spiral fractures commonly require stable internal fixation to prevent rotation.
`S82.891A`	Other fracture of lower leg, right leg, initial encounter for closed fracture	Catch-all for atypical tibial fractures that may be treated with `CPT 27758`.
`S82.011A`	Fracture of medial malleolus, right leg, initial encounter for closed fracture	Included when distal tibial involvement or concurrent ankle fractures alter fixation planning; may influence operative approach.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99223`	Initial hospital care, typically 70 minutes or more, per day, for the evaluation and management of a seriously ill patient	Used for complex inpatient preoperative or postoperative evaluation for patients requiring high-complexity management around the time of `CPT 27758`.
`73560`	Radiologic examination, tibia and fibula, complete, minimum of two views	Preoperative and postoperative imaging to evaluate fracture alignment and healing before and after `CPT 27758`.
`73564`	Radiologic examination, tibia and fibula, 3+ views, with comparison or tomography as needed	Alternative imaging code for more complex radiographic series during perioperative care.
`20680`	Removal of deep implant; deep (e.g., plate, screw) from the tibia	Performed if hardware from `CPT 27758` requires later removal for infection, pain, or nonunion.
`27495`	Open treatment of tibial shaft fracture, with or without external fixation, may include fibular fixation when performed — (Note: used for proximal/distal tibial fixation in some contexts)	Related open fixation code for tibial fractures in different anatomic zones; may be considered in coding crosswalks depending on fracture location and payer rules.
`20690`	Arthrocentesis, aspiration and/or injection; large joint or bursa	May be performed if postoperative joint effusion or infection suspicion requires aspiration following `CPT 27758`.

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