CPT® Code 27194

Code deleted. See 27197, 27198.

Official Description

Closed treatment of pelvic ring fracture, dislocation, diastasis or subluxation; with manipulation, requiring more than local anesthesia

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 stabilized by ligaments that connect the right and left coxal bones to the sacrum at the back, while the symphysis pubis, a fibrocartilaginous joint, unites 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 pertains to injuries affecting the sacroiliac joint, whereas diastasis refers to a separation at the symphysis pubis. In cases of pelvic ring injuries, a thorough evaluation is conducted following radiographic studies to assess the stability of the injury. If the injury is determined to be nondisplaced or minimally displaced, the patient is advised to avoid weight-bearing activities and may be provided with crutches or other assistive devices. The CPT® Code 27194 is specifically utilized when a closed treatment involving manipulation of a pelvic ring fracture, dislocation, diastasis, or subluxation is performed. This procedure entails a closed reduction, where the displaced bones or bone fragments are manually manipulated back into a more favorable position to promote optimal healing of the injury.

1. Indications

The closed treatment of pelvic ring fractures, dislocations, diastasis, or subluxations with manipulation is indicated in the following scenarios:

Pelvic Ring Fracture A fracture involving one or more of the fused bones of the pelvic ring, which may require manipulation to ensure proper alignment for healing.
Dislocation An injury characterized by the displacement of bones at the sacroiliac joint, necessitating manipulation to restore normal anatomical positioning.
Diastasis A condition involving the separation of the symphysis pubis, which may require intervention to realign the joint for stability and healing.
Subluxation A partial dislocation of the sacroiliac joint that may require manipulation to correct the alignment of the joint.

2. Procedure

The procedure for closed treatment of a pelvic ring fracture, dislocation, diastasis, or subluxation with manipulation involves several critical steps:

Step 1: Radiographic Evaluation Initially, the patient undergoes separately reportable 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 stable.
Step 2: Assessment of Stability Following the radiographic evaluation, the physician evaluates the stability of the injury. If the injury is found to be nondisplaced or minimally displaced, the physician will proceed with the closed treatment.
Step 3: Closed Reduction In cases where the injury is displaced, a closed reduction is performed. This involves the physician manually manipulating the displaced bones or bone fragments back into their optimal anatomical position. The goal is to realign the structures to facilitate proper healing.
Step 4: Post-Reduction Instructions After the manipulation, the patient is instructed to avoid weight-bearing activities on the affected side. The physician may provide crutches or other walking aids to assist the patient in mobility while protecting the injury during the healing process.

3. Post-Procedure

Post-procedure care following the closed treatment of a pelvic ring fracture, dislocation, diastasis, or subluxation with manipulation includes monitoring for any signs of complications, such as increased pain or instability. Patients are typically advised to adhere to weight-bearing restrictions and utilize assistive devices as needed. Follow-up appointments are essential to assess the healing process through additional imaging and clinical evaluation. The physician may adjust the treatment plan based on the patient's recovery progress and any changes in the stability of the injury.

Short Descr	TREAT PELVIC RING FRACTURE
Medium Descr	CLTX PEL RING FX DISLC DIAST/SUBLXTJ W/MANJ ANES
Long Descr	Closed treatment of pelvic ring fracture, dislocation, diastasis or subluxation; with manipulation, requiring more than local anesthesia
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)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	2 - Co-surgeons permitted and no documentation required if the two- specialty requirement is met.
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