CPT® Code 27193

Code deleted. See 27197, 27198.

Official Description

Closed treatment of pelvic ring fracture, dislocation, diastasis or subluxation; without manipulation

Common Language Description

The pelvic ring is a complex structure formed by the fusion of the ilium, ischium, and pubis bones on each side of the pelvis. At birth, these bones are separate, but they gradually fuse into a single bone known as the coxal or innominate bone as a person matures into adulthood. The pelvic ring is crucial for supporting the weight of the upper body and facilitating movement. It is stabilized by ligaments that connect the right and left coxal bones to the sacrum at the back, while the symphysis pubis, a fibrocartilaginous joint, connects the bones at the front. Injuries to the pelvic ring can manifest as fractures, dislocations, diastasis, or subluxations, which may involve one or more of the fused bones. Dislocation or subluxation typically indicates an injury to the sacroiliac joint, while diastasis refers to a separation at the symphysis pubis. In cases where a nondisplaced or minimally displaced pelvic ring injury is identified, the stability of the injury is assessed following appropriate radiographic studies. If the evaluation confirms that the bones are in their normal anatomical position, the patient is advised to avoid putting weight on the affected area and may be provided with crutches or other assistive devices for mobility. It is important to note that if manipulation is required to reposition displaced bones, a different procedure code, 27194, should be used to reflect the closed treatment with manipulation.

1. Indications

The closed treatment of pelvic ring fractures, dislocations, diastasis, or subluxations without manipulation is indicated for patients presenting with the following conditions:

Nondisplaced pelvic ring fracture - A fracture where the bone fragments remain in their normal anatomical position.
Minimally displaced pelvic ring fracture - A fracture with slight displacement of the bone fragments that does not require manipulation for realignment.
Pelvic ring dislocation - An injury where the bones of the pelvic ring are misaligned but can be treated without the need for manual repositioning.
Diastasis of the symphysis pubis - A condition characterized by the separation of the pubic bones at the front of the pelvis.
Subluxation of the sacroiliac joint - A partial dislocation of the joint connecting the sacrum and ilium, which can be treated without manipulation.

2. Procedure

The procedure for closed treatment of pelvic ring fractures, dislocations, diastasis, or subluxations without manipulation involves several key steps:

Step 1: Radiographic Evaluation - The first step is to perform radiographic studies to assess the extent of the injury. This imaging is crucial for determining whether the pelvic ring fracture, dislocation, diastasis, or subluxation is displaced or nondisplaced.
Step 2: Stability Assessment - Following the radiographic evaluation, the stability of the injury is assessed. If the injury is determined to be stable, meaning the bones are in their normal anatomical position, the treatment can proceed without the need for manipulation.
Step 3: Patient Instruction - The patient is then instructed to avoid weight-bearing activities to prevent further injury. This may include guidance on using crutches or other walking aids to assist with mobility while protecting the injured area.

3. Post-Procedure

After the closed treatment procedure, the patient is expected to follow specific post-procedure care instructions. This includes adhering to weight-bearing restrictions as advised by the healthcare provider, utilizing crutches or walking aids as necessary, and attending follow-up appointments for ongoing evaluation of the injury's healing process. The patient may also be advised on pain management strategies and signs of complications that should prompt immediate medical attention.

Short Descr	TREAT PELVIC RING FRACTURE
Medium Descr	CLTX PEL RING FX DISLC DIAST/SUBLXTJ W/O MANJ
Long Descr	Closed treatment of pelvic ring fracture, dislocation, diastasis or subluxation; without manipulation
Status Code	Active Code
Global Days	090 - Major Surgery
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	9 - Concept does not apply.
Assistant Surgeon (80, 82)	1 - Statutory payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Procedure or Service, Multiple Reduction Applies
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	P3D - Major procedure, orthopedic - other
MUE	Not applicable/unspecified.
CCS Clinical Classification	148 - Other fracture and dislocation procedure