Secondary closure or scar revision of a below-knee amputation stump through the tibia and fibula, performed after an initial amputation to optimize stump healing and prosthetic fit.

Verified May 8, 2026 · 7 sources ↓

Medicare: $547.77
Work RVU: 8.54
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCMdclarityEmednyZhealthpublishing

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

State explicitly that no bone resection was performed, distinguishing 27884 from re-amputation code 27886
Identify the prior amputation procedure and date to establish the staged relationship for modifier 58 or complication relationship for modifier 78
Describe the specific intervention — secondary wound closure, scar excision, flap advancement, or combination — performed at the stump site
Document the indication: open guillotine wound awaiting closure, wound dehiscence, adherent scar impairing prosthetic fit, or infection requiring surgical debridement with closure
Record anesthesia type, patient positioning, wound measurements, tissue quality, and closure technique (sutures vs. staples, flap configuration)
Note vascular status of flap tissue and any concurrent procedures performed, with NCCI bundling implications addressed

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 51 Multiple procedures 58 Staged or related 76 Repeat, same physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 27884 describes a return surgical procedure on a transtibial (below-knee) amputation stump involving secondary closure of an open wound or revision of scar tissue — without bone resection. This distinguishes it from 27886 (re-amputation, which requires bone resection) and from simple debridement codes. The classic clinical scenario is a guillotine amputation (27882) where the wound was intentionally left open, and 27884 is used for the definitive soft-tissue closure performed days to weeks later. It also covers scar revision to improve stump contour or relieve adherent scarring that would impede prosthetic use.

The 90-day global period governs billing behavior. Because 27884 is almost always staged after a prior amputation, modifier 58 is the standard tool to report it during the global period of the initial procedure — it signals a planned, staged procedure and resets the global clock. If the return to the OR is unplanned due to wound complications (dehiscence, infection), use modifier 78 instead. Never use 78 and 58 on the same encounter; choose based on whether the return was planned or unplanned.

Selection between 27884 and adjacent codes is one of the most common audit triggers in this family. Key distinctions: 27884 = soft tissue only (secondary closure or scar revision); 27886 = bone is resected at a more proximal level; debridement codes (e.g., 11042 series or 97605 for wound VAC) may be appropriate when no formal closure or revision is performed. Document explicitly whether bone was resected — operative notes that omit this detail invite downcoding or upcoding scrutiny.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (8.54) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (16.4) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	8.54
Practice expense RVU	5.81
Malpractice RVU	2.05
Total RVU	16.4
Medicare national rate	$547.77
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	$547.77
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 27884 get rejected.

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

Modifier 58 omitted when billing during the global period of 27880 or 27882, causing denial as a duplicate or bundled service
Code selected as 27886 (re-amputation) instead of 27884 when no bone was resected, or vice versa — operative note lacks explicit statement about bone involvement
Debridement codes (11042 series) billed on the same date as 27884 without a modifier, triggering NCCI bundling edit
Modifier 78 used when the return to OR was actually planned and staged, or modifier 58 used for an unplanned complication-driven return — payer flags the mismatch against prior claim dates
Insufficient documentation of medical necessity for surgical closure versus advanced wound care alternatives, especially in peripheral vascular disease patients

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What is the difference between 27884 and 27886?

27884 is soft tissue only — secondary closure or scar revision with no bone resection. 27886 requires bone resection at a more proximal level. The operative note must explicitly state whether bone was cut. Selecting the wrong code based on an ambiguous note is a top audit flag in this code family.

02When a guillotine amputation (27882) is followed by definitive closure, which code applies and what modifier is needed?

Use 27884 for the closure. Because the procedure is planned and staged following 27882, append modifier 58. This reports it as a staged related procedure, resets the global period, and prevents denial as a duplicate service during the 90-day global of the initial amputation.

03Should modifier 78 or 58 be used for a return to the OR for wound dehiscence after below-knee amputation?

Use modifier 78 — unplanned return to the OR for a complication related to the original procedure. Modifier 58 is reserved for planned or staged procedures. Applying 58 to an unplanned dehiscence repair will likely be flagged on audit as inconsistent with the prior claim record.

04Can debridement codes be billed on the same day as 27884?

Generally no — debridement is considered part of the surgical work captured by 27884. Bundling edits apply. If a truly distinct and separate debridement of a separate wound site is performed, modifier 59 (or an X modifier) with robust documentation of separate anatomic sites is required to unbundle.

05Does 27884 have a global period, and what does that mean for post-op visits?

Yes — 27884 carries a 90-day global period. All routine post-op stump care visits, dressing changes, and wound checks are bundled into the procedure payment through day 90. Bill post-op E/M services unrelated to the amputation stump with modifier 24. Stump-related complications managed in the office during the global period are also bundled unless they require a return to the OR.

06Is 27884 appropriate when a wound VAC is placed on a below-knee amputation stump without formal closure?

No. If the operative session consisted only of debridement and wound VAC placement without formal secondary closure or scar revision, 27884 is not supported. Consider 11042-series debridement codes or 97605/97606 for wound VAC, depending on the procedure performed and documentation. The choice hinges on whether formal surgical closure or revision occurred.

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 operative dictation details that define 27884 specifically: whether bone was resected (key to distinguishing 27884 from 27886), the nature of the intervention (secondary closure vs. scar revision), the clinical relationship to the prior amputation procedure, and whether the return to the OR was planned or unplanned. That captured context auto-populates the correct modifier — 58 for staged, 78 for unplanned complication — preventing the most common denial in this code family.

See how Mira captures CPT 27884 documentation