Summary & Overview
CPT 27759: Tibial Shaft Intramedullary Nailing
CPT code 27759 denotes intramedullary nailing of a tibial shaft fracture, a common operative procedure used to stabilize long-bone fractures, maintain alignment, and relieve pain during healing. This code captures treatment that places a nail or rod within the tibial intramedullary canal and may include interlocking screws or cerclage; any concomitant fibular fracture is not addressed separately under this code. Nationally, intramedullary fixation of tibial shaft fractures is a high-impact orthopedic trauma service with implications for inpatient and outpatient surgical capacity, device utilization, and payer reimbursement policy.
Key payers commonly referenced in coverage and payment discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical procedure and sites of care, typical coding context, common modifiers, and what to expect in payer coverage and claims processing. The publication also outlines benchmarking areas such as expected service setting and typical utilization drivers, and it highlights policy and billing considerations relevant to hospitals, ambulatory surgical centers, and orthopedic practices.
Data not available in the input: specific ICD-10 diagnoses, associated taxonomies, and payer-specific reimbursement rates.
Billing Code Overview
CPT code 27759 describes surgical fixation of a tibial shaft fracture by inserting an intramedullary nail or rod into the tibial intramedullary canal. The procedure may include placement of interlocking screws and/or cerclage to stabilize the fracture and maintain alignment while the bone heals. The provider may encounter an associated fibular fracture but does not treat the fibula separately as part of this service.
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Service type: Surgical fracture fixation (open or closed intramedullary nailing of the tibial shaft)
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Typical site of service: Hospital operating room or ambulatory surgical center for orthopedic trauma surgery
Clinical & Coding Specifications
Clinical Context
A 38-year-old male construction worker presents after a fall from scaffolding with acute pain, deformity, and inability to bear weight on the right lower extremity. Radiographs and CT confirm a displaced midshaft tibial fracture with minimal comminution and an intact or simply fractured fibula. The orthopedic trauma surgeon performs intramedullary nailing of the tibia (27759) in an operating room under general or regional anesthesia. The workflow includes preoperative imaging and templating, intraoperative fluoroscopic guidance for reduction, insertion of an intramedullary nail with or without interlocking screws and cerclage wires, intraoperative assessment of length, alignment, and rotation, wound closure, and postoperative radiographs. Typical perioperative documentation includes indication, fracture description (level, displacement, comminution), approach, implant type and size, use of interlocking screws, estimated blood loss, complications (if any), and postoperative plan for weight-bearing and follow-up.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, or complexity substantially exceeds typical for 27759 (must document why). |