Fasciotomy for Compartment Syndrome

CPT 27602 · 7.62 wRVU · 90-day global
CPT27602
wRVU7.62
Global90-day
ApproachOpen
ComplexityModerate
Add-on / Variant CPTs
  • 27600 wRVU: 5.88 — Decompression of lower leg, anterior and/or lateral compartments only (5.88 wRVU, 90-day global) — use when only anterior or anterior + lateral compartments are released
  • 27601 wRVU: 5.9 — Decompression of lower leg, posterior compartment(s) only (5.90 wRVU, 90-day global)
  • 27892 wRVU: 7.74 — Decompression of lower leg with debridement (7.74 wRVU, 90-day global) — leg code (NOT thigh); use when nonviable muscle debridement is performed at the same session
  • 27496 wRVU: 6.61 — Decompression of thigh/knee, 1 compartment, without debridement (6.61 wRVU, 90-day global) — correct code for thigh fasciotomy; thigh has three compartments (anterior, medial/adductor, posterior)
  • 27497 wRVU: 7.6 — Decompression of thigh/knee, 1 compartment, with debridement (7.60 wRVU, 90-day global)
  • 27499 wRVU: 9.19 — Decompression of thigh/knee, multiple compartments with debridement (9.19 wRVU, 90-day global)
  • 25024 wRVU: 10.52 — Decompression, forearm, flexor AND extensor compartments (volar and dorsal), without debridement (10.52 wRVU, 90-day global) — standard code for forearm compartment syndrome
  • 25025 wRVU: 17.49 — Decompression, forearm, flexor AND extensor compartments, with debridement (17.49 wRVU, 90-day global)
  • 26037 wRVU: 7.38 — Decompressive fasciotomy, hand (excluding injection injury; 7.38 wRVU, 90-day global) — correct code for hand compartment syndrome; do NOT use 26035 (injection injury) or 26040 (Dupuytren release)
Preoperative Diagnosis:

Acute compartment syndrome, [right / left] [leg / forearm / thigh]

Postoperative Diagnosis:

Same

Procedure Performed:

Four-compartment fasciotomy, [right / left] leg [or specify location]

Attending Surgeon:

[Attending name], MD

First Assistant:

[Resident/Fellow/PA name]

Anesthesia:

General / spinal

Indications:

Patient presents with [trauma / reperfusion / cast-related / crush injury] resulting in acute compartment syndrome of the [right / left] [lower leg / forearm]. Clinical findings include [pain with passive stretch, tense compartments, paresthesias, diminished pulses]. Compartment pressures measured: [anterior X mmHg, lateral X mmHg, superficial posterior X mmHg, deep posterior X mmHg]. Delta pressure <30 mmHg in [compartment]. Emergent fasciotomy indicated. Risks including wound complication, infection, scarring, and need for skin grafting discussed.

Findings:

[Tense / severely tense] compartments on palpation. Skin intact [or compromised]. [Distal pulses [present / diminished / absent].] Muscle [viable / dusky] at time of fasciotomy. [All four compartments released with visible muscle expansion.]

Description of Procedure:

The patient was brought emergently to the operating room. The extremity was prepped and draped in sterile fashion. [No tourniquet used to allow assessment of tissue viability.]

LATERAL INCISION: A longitudinal incision was made approximately 2 cm anterior to the fibula, extending from just below the fibular head to above the lateral malleolus. The superficial peroneal nerve was identified along the anterior intermuscular septum and protected throughout. The anterior compartment fascia was incised longitudinally under direct vision with scissors, releasing the anterior compartment. The lateral compartment fascia was incised on the opposite side of the septum, releasing the lateral compartment.

MEDIAL INCISION: A second longitudinal incision was made 1-2 cm posterior to the posteromedial tibial border. The superficial posterior compartment fascia was incised. The soleus muscle bridge was divided to access and release the deep posterior compartment. Tibialis posterior and flexor digitorum were visualized.

All four compartments released. Muscle appeared [viable / dusky / necrotic at X location]. [Fasciotomy sites left open / partially closed with vessel loops.] [Any necrotic muscle debrided.] Wounds dressed with [Xeroform / VAC / moist gauze].

Patient tolerated the procedure well. Plan for repeat washout in [48-72 hours] and delayed primary closure or skin grafting.

Complications:

None

Specimens:

[Muscle biopsy if viability uncertain / None]

Estimated Blood Loss:

Minimal to [X] mL

Drains:

Wounds left open / VAC dressings applied

Disposition:

Patient taken to PACU in stable condition. Return to OR planned in [48] hours.

Epic SmartPhrase Version 
PREOPERATIVE DIAGNOSIS: Acute compartment syndrome, [right / left] [leg / forearm / thigh]
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: Four-compartment fasciotomy, [right / left] leg
ATTENDING SURGEON: ***, MD/DO
FIRST ASSISTANT: ***
ANESTHESIA: General / spinal

INDICATIONS: The patient is a .PTAGE-year-old .PTSEX presenting emergently with acute compartment syndrome of the [right / left] [lower leg / forearm] following [trauma / reperfusion / crush injury]. Clinical findings: pain with passive stretch, tense compartments, paresthesias. Measured compartment pressures: anterior *** mmHg, lateral *** mmHg, superficial posterior *** mmHg, deep posterior *** mmHg. Delta pressure <30 mmHg. Emergent fasciotomy indicated. Risks including wound complication, infection, scarring, and need for skin grafting were discussed.

FINDINGS: Severely tense compartments on palpation. Skin intact. Distal pulses [present / diminished]. Muscle [viable / dusky] at fasciotomy. All four compartments released with visible muscle expansion.

DESCRIPTION OF PROCEDURE:
Patient taken emergently to OR. Extremity prepped in sterile fashion. No tourniquet. LATERAL INCISION: Longitudinal incision approximately 2 cm anterior to fibula, from below fibular head to above lateral malleolus. Superficial peroneal nerve identified along anterior intermuscular septum and protected. Anterior compartment fascia incised longitudinally under direct vision. Anterior compartment released. Lateral compartment fascia incised. Lateral compartment released. MEDIAL INCISION: Second longitudinal incision 1-2 cm posterior to posteromedial tibial border. Superficial posterior compartment fascia incised. Soleus bridge divided to access and release the deep posterior compartment. Tibialis posterior and flexor digitorum visualized. All four compartments confirmed released. Muscle [viable / dusky at ***; necrotic tissue debrided]. Fasciotomy wounds left open and dressed with [Xeroform / VAC / moist gauze]. Patient tolerated the procedure well. Plan for return to OR in 48-72 hours for washout and delayed closure or skin grafting.

ESTIMATED BLOOD LOSS: Minimal
SPECIMENS: [Muscle biopsy if viability uncertain / None]
COMPLICATIONS: None
DRAINS: Wounds left open. VAC/moist gauze dressings applied.
DISPOSITION: Patient taken to PACU in stable condition. Return to OR planned in 48 hours.

Signed: .ME, .MYDEGREE
.TODAY
Variants

Forearm fasciotomy

Two-space (volar and dorsal) release: CPT 25024 (without debridement, 10.52 wRVU) or CPT 25025 (with debridement, 17.49 wRVU). Incisions: volar Henry approach and dorsal midline. Releases volar superficial flexors, deep flexors, and mobile wad (brachioradialis, ECRL, ECRB). If carpal tunnel release performed concurrently, document separately (CPT 64721); modifier -59 or XS may be required to unbundle from the forearm fasciotomy code.

Thigh fasciotomy

The thigh has three compartments: anterior (quadriceps), medial (adductors), and posterior (hamstrings). Standard approach: lateral incision releasing anterior and posterior compartments. If medial (adductor) compartment is involved, a separate medial incision is required. Correct CPT codes: 27496 (1 compartment, without debridement), 27497 (1 compartment, with debridement), 27498 (multiple compartments, without debridement), 27499 (multiple compartments, with debridement). Do NOT use 27892 — that is a lower leg (not thigh) code.

Delayed primary closure

Document use of vessel loops (shoelace technique) for gradual wound closure at return visit, or skin graft if unable to close primarily. Bill with modifier -58 (planned staged procedure) when return was anticipated at the time of initial fasciotomy.

Charting Tips
  • Document all measured compartment pressures and delta pressure calculation (diastolic BP minus compartment pressure; surgical threshold <30 mmHg per McQueen and Court-Brown)
  • State all four compartments decompressed individually
  • Lateral incision: document identification and protection of the superficial peroneal nerve
  • Describe muscle viability in each compartment, as this determines need for debridement
  • Wounds must be left open; document this explicitly
  • Plan for return to OR at 48-72 hours must be stated
  • Any muscle debridement performed should be documented by compartment
  • {'ICD-10': 'use T79.A- for traumatic compartment syndrome (T79.A21 right leg, T79.A22 left leg, T79.A11 right forearm, T79.A12 left forearm)'}
Billing Tips
  • Lower leg fasciotomy codes — select based on compartments released: 27600 (anterior compartment only, or anterior + lateral, 5.88 wRVU), 27601 (posterior compartments only, 5.90 wRVU), 27602 (anterior and/or lateral AND posterior compartments — i.e., all four compartments, 7.62 wRVU). A standard four-compartment leg fasciotomy is 27602. Bill based on compartments released, not incision count. CPT 27892 (decompression of leg with debridement, 7.74 wRVU) applies when nonviable muscle debridement is also performed — it is a leg code, not a thigh code.
  • Forearm fasciotomy: 25024 (volar AND dorsal compartment release without debridement, 10.52 wRVU) or 25025 (with debridement, 17.49 wRVU) for the standard two-space forearm release. Use 25020 (single compartment, flexor OR extensor, without debridement, 5.91 wRVU) or 25023 (single compartment with debridement, 13.48 wRVU) only when a single compartment is released. CPT 24495 (forearm fasciotomy with brachial artery exploration, 8.20 wRVU) is specifically for cases involving brachial artery exploration — not a generic forearm fasciotomy code.
  • Hand compartment syndrome decompression: CPT 26037 (decompressive fasciotomy, hand, 7.38 wRVU). Do NOT use 26035 for hand compartment syndrome — 26035 (11.09 wRVU) is specifically for high-pressure injection injuries (paint gun, grease gun) as stated in its descriptor. Do NOT use 26040 — that code is for palmar release of Dupuytren contracture (percutaneous, 3.37 wRVU), not compartment syndrome.
  • Global period is 90 days (major). Staged closure and secondary procedures within the global period (delayed primary closure, skin grafting) require modifier -58 (planned staged procedure) to be separately billable. Modifier -58 applies when the return was planned at the time of the initial procedure; use -78 for unplanned returns due to complications.
  • Skin grafting for fasciotomy wound closure is separately billable with 15100 (STSG trunk/arm/leg, first 100 sq cm, 9.65 wRVU) + 15101 add-on per additional 100 sq cm (1.68 wRVU). Document graft area in sq cm.
  • If bilateral extremities are released, bill each side separately with -RT/-LT modifiers. Bilateral rate is 150% of the single-side unilateral fee schedule amount.
  • ICD-10 coding: traumatic compartment syndrome (crush, reperfusion, cast, fracture) = T79.A- (e.g., T79.A21 for right lower extremity, T79.A22 left lower extremity). Nontraumatic compartment syndrome (exertional, postoperative without injury) = M79.A-. Most fasciotomies in this template involve traumatic etiology — use T79.A-, not M79.A-. This distinction affects DRG grouping and payer authorization.

General coding reference. Verify with your institution’s billing department before submitting claims.

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