Surgical · Hip

Open circular (guillotine) amputation of the thigh, transecting the femur at any level with a circumferential incision through skin, muscle, and bone — wound left open for staged closure or revision.

Verified May 8, 2026 · 6 sources ↓

Medicare: $628.27
Total RVUs: 18.81
Global, days: 90
Region: Hip

Drawn from CMSAAPCNIHGenhealthZhealthpublishing

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Operative note must explicitly describe a circular (guillotine) incision technique — not flap-based closure
Document the specific femoral level of transection (proximal, mid, or distal third of femur)
State the clinical indication requiring open wound management (e.g., infection, gangrene, traumatic contamination, vascular compromise with necrosis)
Record vessel ligation method and confirmation of hemostasis
Note the wound disposition — open, packed, or vacuum-assisted — and the plan for staged revision or closure
Include pre-operative imaging, cultures, or vascular studies supporting the decision for guillotine technique over primary-closure amputation

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 58 Staged or related 74 Discontinued post-anesthesia 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

27592 covers a guillotine-style transfemoral amputation: a circular incision through all soft tissue layers down to the femur, transection of the bone at the selected level, vessel ligation, and intentional wound-open management. The open technique is chosen specifically when infection control takes priority over primary closure — the wound is left to granulate or is revised in a subsequent definitive amputation (27594 or 27596). That staged intent is central to the coding distinction.

This is not the same as a standard transfemoral amputation with flap closure. If you're billing 27592, the operative note must describe the circular, open technique and document why primary closure was not performed — typically severe infection, gas gangrene, vascular compromise with necrosis, or trauma contamination. Coders who default to 27592 for any thigh amputation without confirming the open, circular approach will face medical necessity denials on audit.

The 90-day global applies. All routine post-operative management, wound checks, and dressing changes through day 90 are bundled. Modifier 78 covers an unplanned return to the OR for a related procedure (e.g., revision or irrigation) during the global. If the definitive revision amputation is planned and staged, use modifier 58 on the follow-up code — not 78.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	10.71
Practice expense RVU	5.49
Malpractice RVU	2.61
Total RVU	18.81
Medicare national rate	$628.27
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	$628.27
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 27592 get rejected.

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

Operative note describes flap closure or myoplasty — inconsistent with the open circular technique required for 27592
Medical necessity not established when documentation lacks explicit clinical rationale for leaving the wound open (infection, gangrene, contamination)
Wrong code selected when a definitive amputation with flap closure was performed — should be 27594 or 27596 instead
Modifier missing on same-day or global-period related procedures billed without 78 or 58 as appropriate
ICD-10 diagnosis mismatch — submitting a traumatic amputation diagnosis code when the procedure was performed for infection or vascular disease, or vice versa

Frequently asked questions

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

01What is the difference between 27592 and 27594?

27592 is the open, circular (guillotine) amputation left without primary closure — a staged procedure for infection or contamination control. 27594 is the secondary closure or scar revision following a prior open amputation. They represent sequential stages of the same clinical episode, not interchangeable codes for the same day.

02When should modifier 58 vs. modifier 78 be used for the follow-up definitive amputation?

Use modifier 58 on the definitive revision (e.g., 27596) when it was planned and staged from the outset — documented as a staged procedure in the original operative note. Use modifier 78 only for an unplanned return to the OR during the global for a related complication. Inverting these modifiers triggers payment errors and audit flags.

03Does the 90-day global include wound care for the open guillotine wound?

Yes. Routine wound checks, dressing changes, and packing changes during the 90-day global are bundled into 27592. Separately billing wound care services during the global without modifier 24 (for unrelated E/M) will be denied.

04Can 27592 be billed in an ASC setting?

It has an ASC payment rate established under CMS 2026 — see the site-of-service comparison table. Whether a specific payer and ASC will approve the case depends on clinical stability and payer policy; emergency or critically ill patients are typically managed in the hospital setting.

05What ICD-10 diagnoses are typically paired with 27592?

Common pairings include gas gangrene (A48.0), diabetic foot infection with osteomyelitis, peripheral artery disease with gangrene (I70.261–I70.269 range), and traumatic open injuries with severe contamination. The ICD-10 must align with the open technique rationale — a mismatch between a clean traumatic amputation code and the guillotine technique is a common denial trigger.

06Is an assistant surgeon billable with 27592?

An assistant surgeon may be reported using modifier 80 or AS (for a physician assistant or NP acting as assistant). Medicare assistant-at-surgery rules apply — confirm the procedure qualifies for assistant reimbursement under the applicable MAC's policy before billing.

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 surgeon's dictated incision description (circular vs. flap), the femoral transection level, the stated indication (infection grade, gangrene extent, vascular findings), vessel ligation technique, and the explicit wound-open disposition with staged revision plan. That prevents the most common audit flag: an operative note that performs a transfemoral amputation but fails to document why primary closure was withheld — which is the clinical and coding distinction between 27592 and 27594/27596.

See how Mira captures CPT 27592 documentation