Periacetabular Osteotomy

Question:

We have a new pediatric orthopaedic surgeon who has joined our practice. He recently performed periacetabular osteotomies for hip dysplasia. He wants us to report CPT codes 27228 and 27146 x3 for this procedure based on information he received during his fellowship training. We have told him that we must report an unlisted CPT code. Will you advise if we can report the codes he suggests, or is the unlisted CPT code correct?

Answer:

There are two options to report this service based on whether the payor follows Medicare rules or not:

• From a CPT standpoint, the correct Category I CPT code is 27299 (Unlisted procedure, pelvis or hip joint).
• A Level III HCPCS code exists (S2115 Osteotomy, periacetabular, with internal fixation) for payors who recognize S codes; Medicare does not recognize these level three codes. These codes were commonly referred to as “local codes” and are not published in the CPT manual.

CPT code 27228 (Open treatment of acetabular fracture(s) involving anterior and posterior (two) columns, includes T-fracture and both column fracture with complete articular detachment, or single column or transverse fracture with associated acetabular wall fracture, with internal fixation) is incorrect, as the physician is not treating a fracture.

CPT code 27146 (Osteotomy, iliac, acetabular or innominate bone;) is also incorrect, as the surgeon is not performing a single osteotomy of any one of these bones; the surgeon is performing multiple osteotomies, or cuts in the acetabulum.

*This response is based on the best information available as of 12/05/19.