HCPCS G0414: Open Treatment of Anterior Pelvic Bone Fracture with Internal Fixation - OpenPayer

Summary & Overview

HCPCS G0414: Open Treatment of Anterior Pelvic Bone Fracture with Internal Fixation

HCPCS Level II code G0414 represents open surgical treatment of anterior pelvic bone fractures and dislocations that disrupt the pelvic ring, and it includes internal fixation when performed. This procedure addresses serious injuries to the pubic symphysis and superior or inferior rami and typically involves complex orthopedic surgical care in a hospital setting. Nationally, pelvic ring disruptions carry significant clinical and resource implications because of their association with major trauma, potential hemorrhage, and prolonged inpatient recovery.

Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise overview of clinical context, service setting, and the typical billing considerations associated with G0414 for these major payers.

Readers will learn the clinical scope of the code, common sites of service, and which payers are most relevant to coverage and claims processing. The report also outlines available benchmarks and any notable policy updates when present, and it situates G0414 within orthopedic trauma care for national payer audiences. Data not available in the input is clearly noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG0414HCPCS Level IIpelvic fractureorthopedic surgeryinternal fixationpelvic ring disruptionhospital inpatienttrauma surgery

Billing Code Overview

HCPCS Level II code G0414 describes the open treatment of anterior pelvic bone fracture and/or dislocation for fracture patterns that disrupt the pelvic ring, unilateral or bilateral. The description specifies that the procedure includes internal fixation when performed and explicitly includes treatment of the pubic symphysis and/or superior and inferior rami.

Service type: Surgical orthopedic procedure — open pelvic fracture repair with possible internal fixation

Typical site of service: Hospital operating room or inpatient surgical service, as this procedure addresses complex pelvic ring disruptions that commonly require inpatient perioperative care.

Clinical & Coding Specifications

Clinical Context

A 47-year-old male presents to the emergency department after a high-energy motor vehicle collision with pelvic pain, hemodynamic stability after resuscitation, and inability to ambulate. Imaging (pelvic radiographs and CT) demonstrates a displaced anterior pelvic ring fracture with pubic symphysis disruption and ipsilateral superior pubic ramus fracture causing pelvic ring instability. After multidisciplinary trauma evaluation, the patient is scheduled for open reduction and internal fixation of the anterior pelvic ring to restore stability and allow mobilization. The clinical workflow includes preoperative trauma assessment, informed consent, general anesthesia, open reduction of the pubic symphysis and/or rami, internal fixation with plates and screws as indicated, intraoperative imaging confirmation, postoperative pain control, thromboprophylaxis, and inpatient recovery with early physical therapy and outpatient follow-up for wound checks and radiographic healing assessment.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work or time is substantially greater than typical for open anterior pelvic fixation due to complexity, extensive dissection, or intraoperative complications.
`23`

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HCPCS-G9960-DOCUMENTATION-SYSTEMIC-ANTIMICROBIAL-REASON

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HCPCS-G2077-PERIODIC-ASSESSMENT-OPIOID-TREATMENT-PROGRAM

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Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`207L00000X`	Orthopaedic Surgery	Primary specialty performing open pelvic ring fixation and internal fixation.
`2080P0208X`	General Surgery (Trauma)	Trauma/general surgeons often participate in initial management and stabilization in polytrauma patients.
`2084P0800X`	Surgery of the Hand & Upper Extremity — not applicable	Data not available in the input.
`208500000X`	Anesthesiology	Provides general or regional anesthesia for pelvic fixation procedures.
`367A00000X`	Physical Therapist	Manages postoperative mobilization and rehabilitation.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S32.2`	Fracture of pubis	Directly describes fractures of the pubic rami or pubic symphysis that may require open reduction and internal fixation.
`S32.3`	Fracture of ilium	May accompany pelvic ring injuries requiring comprehensive stabilization.
`S32.4`	Fracture of acetabulum	Can coexist with anterior pelvic ring fractures and influence surgical planning.
`S32.89`	Other fractures of pelvis	Captures less specific pelvic fractures that disrupt the pelvic ring and may necessitate open fixation.
`S32.7`	Multiple fractures of pelvis	Represents complex pelvic ring injuries involving multiple pelvic elements requiring operative fixation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`27236`	Open treatment of pelvic ring disruption (eg, iliosacral screw, external fixation)	May be used for posterior pelvic ring fixation performed in conjunction with anterior pelvic ring open fixation when indicated.
`27244`	Open treatment of pelvic ring fracture, includes internal fixation, anterior and posterior approaches	Represents comprehensive pelvic ring reconstruction codes that may be reported when combined anterior and posterior procedures are performed.
`20690`	Application of external fixation device (when performed)	Used when supplemental external fixation is placed for temporary or definitive stabilization in pelvic fractures.
`23460`	Closed treatment codes — not applicable to pelvis	Data not available in the input.
`72195`	Injection procedures for sacroiliac joint — not directly related	May be used for diagnostic or pain management procedures in complex pelvic pain but not typically billed with open anterior pelvic fixation.

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