Summary & Overview
HCPCS G0412: Open Treatment of Iliac Spine or Iliac Wing Fracture
HCPCS Level II code G0412 denotes open surgical treatment of iliac spine(s), tuberosity avulsion, or iliac wing fractures when pelvic ring integrity is maintained, with internal fixation included if performed. This code captures a specialized orthopedic operative procedure used in trauma and reconstructive care of the pelvis. Nationally, accurate use of G0412 supports correct clinical documentation, appropriate facility billing, and consistent classification of complex pelvic fracture management.
Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, guidance on expected site-of-service coding, and benchmarks and policy-relevant considerations for payer coverage and claim adjudication. The publication summarizes typical billing modifiers and common payment contexts where available and explains implications for facility billing lines and surgical service reporting.
The content that follows provides: a clinical and coding overview of the procedure, expected service line and site-of-service interpretations, common modifiers used in practice, and notes on payer coverage patterns and policy updates. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code G0412 describes open treatment of iliac spine(s), tuberosity avulsion, or iliac wing fracture(s), unilateral or bilateral for pelvic bone fracture patterns that do not disrupt the pelvic ring. The procedure description indicates that internal fixation, when performed, is included in the service.
-
Service type: Open surgical fixation of iliac spine, tuberosity avulsion, or iliac wing fractures
-
Typical site of service: Acute care hospital operating room or inpatient surgical setting for pelvic fracture repair
Clinical & Coding Specifications
Clinical Context
A 42-year-old male motorcyclist presents to the emergency department after a high-energy lateral impact. He reports severe left pelvic pain and inability to bear weight. CT pelvis demonstrates an isolated left iliac crest avulsion fracture with displacement of the iliac spine/tuberosity without disruption of the pelvic ring. The orthopedic trauma team admits the patient for open reduction and internal fixation due to significant displacement and muscular pull causing functional impairment. Preoperative workflow includes informed consent, anesthesia evaluation (general anesthesia), perioperative antibiotics, and imaging review. Intraoperative steps include open exposure of the iliac wing/crest, reduction of the avulsed fragment, fixation with screws and/or plates as indicated, hemostasis, and layered closure. Postoperative care involves inpatient pain control, DVT prophylaxis, wound checks, weight-bearing restrictions specific to fixation stability, physical therapy initiation, and outpatient follow-up with radiographic surveillance until healing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
50 | Bilateral procedure | When the open treatment/fixation is performed on both iliac wings/spines during the same operative session |
62 | Two surgeons | When two surgeons from different specialties concurrently perform distinct portions of the procedure |
66 | Surgical team (metropolitan areas) | When a documented surgical team approach is used per payer/surgical team rules |
73 | Discontinued outpatient procedure prior to anesthesia administration | When the procedure is canceled after patient preparation but before anesthesia |
78 | Return to OR for related procedure during global period | When an unplanned reoperation for a complication of the index fixation occurs within the global period |
80 | Assistant surgeon | When an assistant (resident or physician assistant as allowed) provides active surgical assistance |
81 | Minimum assistant surgeon | When a lesser level of assistance is documented and accepted by payer rules |
82 | Assistant surgeon (when qualified resident not available) | When assistant services are furnished by an assistant surgeon because a qualified resident is unavailable |
52 | Reduced services | When the procedure is partially reduced in scope or complexity compared with the full service |
53 | Discontinued procedure after anesthesia started | When the operation is terminated after anesthesia induction for patient safety |
22 | Increased procedural services | When work, time, or complexity substantially exceeds typical service (documented) |
26 | Professional component | When reporting separate professional interpretation or physician component of a distinct service (rare for operative codes) |
56 | Preoperative management only | When only the preoperative portion is performed by a different physician and billed separately per payer rules |
23 | Unusual anesthesia for procedure | When general anesthesia is not used and unusual circumstances require a different anesthesia approach |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207X00000X | Orthopedic Surgery | Primary specialty performing open pelvic fixation and iliac avulsion repairs |
2080P0206X | Orthopedic Trauma Surgery | Subspecialty focus on pelvic and acetabular fractures and complex fixation |
208000000X | General Surgery | May be involved for associated abdominal/pelvic visceral concerns in polytrauma |
207L00000X | Plastic Surgery | Occasionally involved for complex soft-tissue or reconstructive closure over iliac defects |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
S32.44XA | Nondisplaced fracture of iliac crest, initial encounter for closed fracture | Typical code for an iliac crest/wing fracture presenting for initial treatment |
S32.45XA | Displaced fracture of iliac crest, initial encounter for closed fracture | Used when displacement mandates open reduction and internal fixation |
S32.49XA | Fracture of other parts of ilium, initial encounter for closed fracture | Captures other iliac wing or tuberosity fracture variants treated operatively |
S32.3XXA | Fracture of pubis, initial encounter for closed fracture | Frequently assessed to exclude pelvic ring involvement; codes used if coexisting |
S32.4XXA | Fracture of acetabulum, initial encounter for closed fracture | Included when acetabular involvement is present or suspected in pelvic trauma |
S32.80XA | Multiple pelvic fractures, initial encounter for closed fracture | Used for complex pelvic fracture patterns that may include iliac wing injuries |
S32.49XD | Fracture of other parts of ilium, subsequent encounter for closed fracture with routine healing | For follow-up visits after definitive fixation |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
27245 | Open treatment of pelvic ring disruption, internal fixation, includes external fixation when performed | Performed for pelvic ring–disrupting injuries; used when pattern extends beyond isolated iliac avulsion |
27244 | Open treatment of pelvic fracture, includes internal fixation, when performed, for acetabular or pelvic fractures not involving pelvic ring disruption | May be used for more extensive pelvic fixation procedures adjacent to iliac wing repairs |
20680 | Removal of implant; deep (e.g., buried plates, screws) | Performed later if hardware removal is required after healing or for pain/complication |
20670 | Open treatment of peri-prosthetic fracture, with internal fixation, when performed | Relevant when fixation involves peri-implant or complex revision scenarios |
73510 | Radiologic exam, pelvis; single view, frontal | Preoperative or postoperative plain film imaging commonly used for localization and follow-up |
73700 | MRI, lower extremity other than joint; without contrast | Used selectively for soft-tissue assessment or occult concurrent injuries when indicated |