Open treatment of a traumatic hip dislocation without the use of internal fixation hardware

Verified May 8, 2026 · 6 sources ↓

Medicare: $869.76
Total RVUs: 26.04
Global, days: 90
Region: Hip

Drawn from CMSAAPCEmednyAAOSCgsmedicare

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 6 cited references ↓

Mechanism of injury establishing traumatic etiology (required to distinguish from developmental/spontaneous dislocation codes)
Documentation that open approach was necessary — e.g., failed closed reduction attempt, interposed tissue, or neurovascular compromise
Named surgical approach (e.g., posterior, anterolateral, Smith-Petersen) in the operative report
Explicit confirmation that no internal fixation devices were placed — absence of fixation is definitional to 27253 vs. 27254
Intraoperative findings including description of joint contents, any osteochondral loose bodies, and condition of the femoral head and acetabulum
Anesthesia type and patient positioning documented in the operative note
Post-reduction stability assessment and fluoroscopic or radiographic confirmation of concentric reduction

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 50 Bilateral procedure 51 Multiple procedures 57 Decision for surgery 58 Staged or related 62 Co-surgeons 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27253 describes open surgical treatment of a traumatic hip dislocation where the femoral head is repositioned into the acetabulum through a direct surgical approach — without placing any internal fixation implants such as pins, screws, or wires. This distinguishes it from 27254, which adds acetabular wall or femoral head fracture management with optional fixation. The open approach is used when closed reduction (27252) has failed or is contraindicated, requiring direct visualization to clear obstructions such as soft tissue interposition, labral entrapment, or osteochondral fragments.

The 90-day global period means all routine post-op visits, wound checks, and dressing changes through day 90 are bundled into the base payment. Any E/M service during that window for an unrelated problem requires modifier 24. If the decision to proceed with open reduction was made at a same-day or day-before E/M visit, append modifier 57 to that E/M — not to the surgical code. Document the approach by name in the operative note; vague references to a 'standard approach' or 'routine exposure' are audit flags.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	13.24
Practice expense RVU	9.97
Malpractice RVU	2.83
Total RVU	26.04
Medicare national rate	$869.76
Global period	90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$869.76
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI G2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 27253 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Wrong code selected — 27254 is required when an acetabular wall or femoral head fracture is also treated; using 27253 when fixation was performed triggers downcoding or denial
Missing documentation of why open treatment was necessary rather than closed reduction, leading to medical necessity denial
Global period conflicts — post-op E/M visits billed without modifier 24 when the condition is unrelated, or without modifier 24 when payer flags the visit as routine global care
ICD-10 diagnosis mismatch — spontaneous or developmental hip dislocations (coded to M24.35x or congenital categories) do not map to traumatic dislocation codes; use S73.0xx for traumatic dislocation
Bilateral modifier 50 applied incorrectly when procedures were performed at separate operative sessions rather than the same session

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01What's the difference between 27253 and 27254?

27253 is open treatment of traumatic hip dislocation without internal fixation. 27254 is used when there is also an acetabular wall or femoral head fracture addressed at the same surgery, with or without internal or external fixation. If you repaired a fracture or placed any hardware, 27253 is wrong — bill 27254.

02Can 27253 and 27252 be billed together if closed reduction was attempted first and failed?

No. When a closed reduction attempt fails and the surgeon proceeds to open treatment in the same operative session, bill only 27253. The failed closed attempt is considered part of the open procedure and is not separately reimbursable.

03What modifier applies if the patient returns to the OR during the global period for a related complication?

Modifier 78 covers an unplanned return to the OR for a complication or related procedure within the 90-day global. If the return procedure is completely unrelated to the hip dislocation, use modifier 79 instead. Never invert these two.

04What ICD-10 codes pair with 27253?

Traumatic hip dislocation codes under S73.0xx (posterior, obturator, or other) are the correct ICD-10 pairings. Using spontaneous or developmental dislocation codes (M24.35x or congenital categories) will trigger a mismatch denial because those dislocations map to 27256–27259.

05Does the 90-day global include the day of surgery?

Yes. The global period for 27253 begins the day before surgery (day -1 for the pre-op visit), includes the day of surgery (day 0), and runs through post-op day 90. Routine follow-up visits in that window are bundled. Use modifier 24 for unrelated E/M services and modifier 57 if the decision for surgery was made at an E/M the day of or day before the procedure.

06Is 27253 appropriate for post-arthroplasty hip dislocations?

No. Post-arthroplasty dislocations are coded separately: 27265 for closed treatment without anesthesia and 27266 for closed treatment requiring anesthesia. If open treatment of a post-arthroplasty dislocation is performed, consult AAOS coding guidance — 27253 is specific to traumatic native hip dislocations.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures the mechanism of injury, failed prior reduction attempts, named surgical approach, intraoperative joint findings, confirmation that no internal fixation was placed, and post-reduction imaging result directly from dictation. This prevents the two most common denials for 27253: miscoding to 27254 when fixation was absent, and medical necessity rejections when the necessity for open over closed treatment isn't explicitly documented.

See how Mira captures CPT 27253 documentation