Multiple Femoral Fractures

Question:

I am wondering about charging both CPT codes 27506 (femur shaft) and 27245 (femur intertrochanteric). There is an NCCI edit indicating that 27245 is included with 27506 per mutually exclusive procedures. The provider is saying these are two separate injuries/entities and we should use a modifier. However, I am not sure if that would be correct since they are both on the same bone, just different locations of it. Can you please explain if it would be appropriate to code both codes for the same femur? It seems they are using one nail to fix both fractures. What if they are two separate fractures, does that make a difference? I am having trouble locating any guidance for this scenario. Thank you for your insight.

Answer:

If one intramedullary implant is being placed to treat an intertrochanteric, peritrochanteric, or subtrochanteric fracture in addition to a femoral shaft fracture, only one code would be used. There is an NCCI edit stating that they are mutually exclusive procedures, and a modifier would not be appropriate to override the edit. 

Modifier 22 Increased Procedural Services may be appended if the documentation supports that the work required to treat the fractures was substantially greater than typically required. 

Code selection of either 27506 or 27245 should be determined by the provider based on which treatment was more extensive. 

*This response is based on the best information available as of 05/07/26.