Learn the Latest in Pelvic Fracture Coding
The 2017 CPT® codebook features some important changes for coding pelvic ring fractures, including the deletion of two codes, the addition of two new codes, and an added parenthetical instruction. Here’s what you need to know about the updates.
Greater Specificity, Differing
Treatments, Justify New Codes
Codes 27193 and 27914 were deleted for 2017, and replaced by two new codes:
27197 Closed treatment of posterior pelvic ring fracture(s), dislocation(s), diastasis or subluxation of the ilium, sacroiliac joint, and/or sacrum, with or without anterior pelvic ring fracture(s) and/or dislocation(s) of the pubic symphysis and/or superior/inferior rami, unilateral or bilateral; without manipulation
27198 Closed treatment of posterior pelvic ring fracture(s), dislocation(s), diastasis or subluxation of the ilium, sacroiliac joint, and/or sacrum, with or without anterior pelvic ring fracture(s) and/or dislocation(s) of the pubic symphysis and/or superior/inferior rami, unilateral or bilateral; with manipulation, requiring more than local anesthesia (ie, general anesthesia, moderate sedation, spinal/epidural)
To explain why these code changes were necessary, you must first understand some basic anatomy.
The pelvis is a ring-like structure composed of two innominate bones (joined at the pubic symphysis) and the sacrum (joined to the innominate bones at the sacroiliac (SI) joint). The pelvic ring consists of two arches: a posterior arch that includes the sacrum, SI joints, and posterior ilium, and a weaker anterior arch that includes the pubic rami bones and symphysis.
Deleted codes 27193 and 27914 referred generically to “pelvic ring fracture, dislocation(s), diastasis or subluxation;” whereas new codes 27197 and 27198 specify “posterior pelvic ring fracture, dislocation(s), diastasis or subluxation.” The distinction is important because posterior fractures and anterior conditions may require different treatment. CPT® 2017 Changes: An Insider’s View explains, “Because posterior pelvic ring fractures may require more observation and may require surgery, separate codes have been established to specifically identify the efforts needed for these distinctly different treatments that were previously identified by a single code.”
New Codes Specify with or without Manipulation
Code 27197 describes closed treatment of posterior pelvic ring fracture, or related acute pathological conditions of the pelvis or adjacent structures, without manipulation. Closed treatment means no incision is made (the provider does not expose the bone). Code 27198 describes the same procedure, with manipulation (the provider manually “moves” the fragments of bone to reduce the fracture and allow for proper healing). Manual reduction of the fracture can be very painful for the patient; as such, 27198 includes more than local anesthesia (e.g., general anesthesia, conscious sedation, or spinal block).
Pelvic fracture is typically the result of trauma, such as from a motor vehicle accident, a fall from height, or a crushing injury. Pelvic fracture often is associated with other serious injuries. CPT® 2017 Changes offers the following clinical example of 27198:
A patient who was involved in a vehicular crash presents with pelvic pain and pain with attempted weight bearing. Imaging studies show minimally displaced fractures of the anterior and posterior portions of the pelvic ring, with ipsilateral fractures of the pubic rami and sacrum. The patient’s fractures are treated with manipulation under nonlocal anesthesia.
When to Report an E/M Code, Instead
Do not report 27197 or 27198 for closed treatment of anterior (vs. posterior) pelvic ring fracture and dislocation(s) of the pubic symphysis and superior/inferior rami (unilateral or bilateral). CPT® now instructs us to report an appropriate evaluation and management (E/M) services code.