Fasciotomy for Compartment Syndrome

CPT 27600
Approach Open
Add-on / Variant CPTs
  • 27602 — Fasciotomy, leg, posterior and/or anterior and/or lateral compartments
  • 27892 — Decompression fasciotomy, thigh
  • 25020 — Fasciotomy, forearm
  • 26040 — Fasciotomy, palmar
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
Patient supine. Emergent procedure. Tourniquet [used / not used].

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, 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 on the anterolateral leg from just below the fibular head to above the lateral malleolus. The anterior compartment fascia was incised longitudinally under direct vision with scissors, releasing the anterior compartment. The peroneus longus muscle was identified and the lateral compartment fascia incised, releasing the lateral compartment.
MEDIAL INCISION: A second longitudinal incision was made 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 on anterolateral leg from below fibular head to above lateral malleolus. Anterior compartment fascia incised longitudinally under direct vision. Anterior compartment released. Peroneus longus identified. Lateral compartment fascia incised. Lateral compartment released. MEDIAL INCISION: Second longitudinal incision 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

CPT 25020. Volar and dorsal incisions releasing the volar (superficial and deep) and mobile wad compartments. Document carpal tunnel release if needed.

Thigh fasciotomy

CPT 27892. Lateral incision releasing anterior and posterior thigh compartments.

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.

Charting Tips
  • Document all measured compartment pressures and delta pressure calculation (diastolic BP - compartment pressure)
  • State all four compartments decompressed individually
  • 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
Billing Tips
  • Lower leg fasciotomy codes: 27600 (anterior compartment only, 5.88 wRVU), 27601 (posterior compartments, 5.90 wRVU), 27602 (anterior + posterior, 7.62 wRVU). Bill based on compartments released, not incision count.
  • Forearm fasciotomy: 24495 (with skin incision, 8.20 wRVU) or 25020/25023 depending on whether muscle is involved. Upper arm decompression uses separate codes.
  • Hand/finger decompression: 26035 (11.09 wRVU) for intrinsic compartments, 26020 for flexor sheath involvement. Document each compartment released.
  • Global period is 90 days (major). Staged closure and secondary procedures within the global period (e.g., delayed primary closure, skin grafting) may require modifier -58 (staged procedure) to be separately billable.
  • Skin grafting for fasciotomy wound closure is separately billable with the appropriate graft code (15100-15115). 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 rate.
  • Document clinical indication (compartment pressures, delta pressure, time from injury). Acute compartment syndrome does not require prior authorization. Correct ICD-10 coding (M79.A-) drives case-mix grouping.