Anterior view
Posterior view Anterior
superior iliac spine Anterior inferior iliac spine Greater trochanter
Iliofemoral ligament (Y ligament of Bigelow) Iliopectineal bursa (over gap in ligaments) Pubofemoral ligament
Obturator crest
Superior pubic ramus
Iliofemoral liagment Ischiofemoral ligament
Zona orbicularis Greater trochanter
Protrusion of synovial membrane
Intertrochanteric crest
Lesser trochanter Anterior superior iliac spine
Anterior inferior iliac spine Iliopubic eminence
Acetabular labrum (fibrocartilaginous) Fat in acetabular fossa (covered by synovial membrane)
Obturator artery Anterior branch Posterior branch Acetabular branch Obturator membrane Transverse acetabular ligament
Lesser trochanter
Ischial tuberosity Ligament of
head of femur (cut)
Intertrochanteric line
Neck of femur Head of femur
Greater trochanter Articular cartilage
Lunate (articular) surface of acetabulum
Joint opened: Lateral view Intertrochanteric line
Lesser trochanter Ischial spine Ischial tuberosity FIGURE 2-37. Hip Joint
The hip joint secures the femur head to the pelvic acetabulum, connecting the axial skeleton to the lower extremity. This synovial ball-and-socket joint is weight-bearing. The bony pelvis is formed by the fusion of ilium, ischium, and pubis, creating the right and left hip bone (os coxae). The head, neck, and greater and lesser trochanters of the femur are considered part of the hip joint.
88 Moderate sedation ✚Add-on code Modifier 51 exempt #Resequenced code
Musculoskeletal System
Netter’s Atlas of Surgical Anatomy for CPT CodingSuperficial dissection
Iliac crest
Gluteal aponeurosis over gluteal medius m.
Gluteus maximus m.
Semitendinosus m.
Biceps femoris m. (long head) Adductor magnus m.
Semimembranosus m. Iliotibial tract
Gracilis m.
Biceps femoris m.
Short head Long head
Gluteus maximus m. (cut)
Inferior gluteal a. and n.
Pudendal n.
Nerve to obturator internus (and superior gemellus) Posterior cutaneous n. of thigh Sacrotuberous lig.
Ischial tuberosity Sciatic n.
Muscular branches of sciatic n.
Semitendinosus m. (retracted) Semimembranosus m.
Gluteal aponeurosis and gluteus medius m. (cut) Superior gluteal a. and n.
Gluteus minimus m.
Tensor fasciae latae m.
Piriformis m.
Gluteus medius m. (cut) Superior gemellus m.
Greater trochanter of femur Obturator internus m.
Inferior gemellus m.
Quadratus femoris m.
Medial circumflex femoral a.
Adductor magnus m.
Deep dissection
Iliac crest
FIGURE 2-38. Muscles of the Hip
Many hip muscles stabilize the hip joint and provide its movement and strength. The muscles fall into four groups based on their location: anterior, posterior, adductor, and abductor. Anterior muscles flex the thigh at the hip and include iliopsoas and quadriceps. Posterior muscles straighten the thigh at the hip. These include gluteus maximus and hamstrings. The adductor group includes groin muscles. The abductors are on the lateral side of the thigh.
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27077 innominate bone, total
27078 ischial tuberosity and greater trochanter of femur 27080 Coccygectomy, primary
Introduction or Removal
Coding Atlas
A foreign body is an object that has become lodged in the body by accident. A prosthesis is an object that has been placed in the body to assume the role of a natural body part, eg, a joint prosthesis.
27086 Removal of foreign body, pelvis or hip; subcutaneous tissue
27087 deep (subfascial or intramuscular) 27090 Removal of hip prosthesis; (separate procedure) 27091 complicated, including total hip prosthesis,
methylmethacrylate with or without insertion of spacer
27093 Injection procedure for hip arthrography; without anesthesia
27095 with anesthesia
27096 Injection procedure for sacroiliac joint, anesthetic/
steroid, with image guidance (fluoroscopy or CT) including arthrography when performed
Repair, Revision, and/or Reconstruction
Coding Atlas
In a unipolar hemiarthroplasty, there is an articulation between the prosthetic head and the native acetabulum.
In bipolar hemiarthroplasty, the prosthetic head has a component that is an artificial acetabulum cup, however, no work is done on the native acetabulum. In a total hip arthroplasty, the native acetabulum is sculpted to fit a prosthetic cup. Hemiarthroplasty, which is reported using code 27125, should not be considered when listing the code for a partial hip replacement that is the result of traumatic hip fracture. For prosthesis placed following hip fracture, see code 27238.
27097 Release or recession, hamstring, proximal 27098 Transfer, adductor to ischium
27100 Transfer external oblique muscle to greater trochanter including fascial or tendon extension (graft)
27105 Transfer paraspinal muscle to hip (includes fascial or tendon extension graft)
27110 Transfer iliopsoas; to greater trochanter of femur 27111 to femoral neck
27120 Acetabuloplasty; (eg, Whitman, Colonna, Haygroves, or cup type)
27122 resection, femoral head (eg, Girdlestone procedure) 27125 Hemiarthroplasty, hip, partial (eg, femoral stem
prosthesis, bipolar arthroplasty)
27130 Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft
27132 Conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft 27134 Revision of total hip arthroplasty; both components, with
or without autograft or allograft
27137 acetabular component only, with or without autograft or allograft
27138 femoral component only, with or without allograft 27140 Osteotomy and transfer of greater trochanter of femur
(separate procedure)
27146 Osteotomy, iliac, acetabular or innominate bone;
27147 with open reduction of hip 27151 with femoral osteotomy
27156 with femoral osteotomy and with open reduction of hip
27158 Osteotomy, pelvis, bilateral (eg, congenital malformation) 27161 Osteotomy, femoral neck (separate procedure)
27165 Osteotomy, intertrochanteric or subtrochanteric including internal or external fixation and/or cast
27170 Bone graft, femoral head, neck, intertrochanteric or subtrochanteric area (includes obtaining bone graft) 27175 Treatment of slipped femoral epiphysis; by traction,
without reduction
27176 by single or multiple pinning, in situ
27177 Open treatment of slipped femoral epiphysis; single or multiple pinning or bone graft (includes obtaining graft) 27178 closed manipulation with single or multiple pinning 27179 osteoplasty of femoral neck (Heyman type procedure) 27181 osteotomy and internal fixation
27185 Epiphyseal arrest by epiphysiodesis or stapling, greater trochanter of femur
27187 Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate, femoral neck and proximal femur
27077—27187
Musculoskeletal System
Netter’s Atlas of Surgical Anatomy for CPT Coding90 Moderate sedation ✚Add-on code Modifier 51 exempt #Resequenced code
Fracture of iliac wing
Fracture of one pubic or ischial ramus
Isolated fracture of one pubic or ischial ramus requires only bed rest until pain diminishes, followed by limited activity for 4–5 weeks, provided there is no visceral or vascular injury.
Impacted transverse fracture that is minimally displaced is most common type. Conservative treatment sufficient unless there is nerve injury.
Sacral laminectomy and bone grafts from ilium used for sharply angulated fractures with nerve injury.
Fracture usually requires no treatment other than care in sitting; inflatable ring helpful.
Pain may persist for long time.
Fracture of coccyx Fractures of sacrum
Avulsions Avulsion of
anterior superior iliac spine due to pull of sartorius muscle
Avulsion of ischial tuberosity due to pull of hamstring muscles
These fractures usually not displaced or minimally displaced and generally require only limitation of activity until pain ceases
Avulsion of anterior inferior iliac spine due to pull of rectus femoris muscle FIGURE 2-39. Pelvic Fracture With No Pelvic Ring Disruption
The ilium, ischium, and pubis form the pelvic ring with the sacrum. Fractures that are through the bone of the ring are documented as “with pelvic ring disruption.” This type of fracture greatly affects the stability of the pelvis. Nondisplaced fractures that do not interrupt the pelvic ring may be effectively treated with bed rest and pain management.
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Fracture and/or Dislocation
Coding Atlas