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The procedure described by CPT® Code 27381 pertains to the suture of the infrapatellar tendon, which is more accurately classified as a ligament connecting the tibia (shinbone) and the patella (kneecap). This tendon, often referred to as the patellar tendon, plays a crucial role in knee stability and movement. The surgical intervention involves a secondary reconstruction, which indicates that this procedure is performed after an initial repair has failed or is inadequate. The operation begins with a midline incision that extends from the top of the patella down to the medial aspect of the tibial tubercle, allowing for adequate access to the affected area. During the procedure, medial and lateral flaps are created to facilitate exploration of the surrounding structures, specifically the medial and lateral retinacula, which are connective tissues that support the knee. The torn infrapatellar tendon is then identified and mobilized, followed by debridement, which involves the removal of damaged tissue. Depending on the location of the tear, additional debridement may be performed on the tibial tubercle and/or the inferior pole of the patella to prepare the site for reconstruction. Sutures are placed in the torn tendon to secure it, and the bony surfaces of the tibial tubercle and/or inferior pole of the patella are prepared for the attachment of the tendon. This preparation may involve drilling tunnels or placing suture anchors to facilitate the secure anchoring of the tendon. The sutures from the tendon are then passed through these tunnels or anchors, effectively securing the infrapatellar tendon to the bone. In some cases, a second drill hole may be created in the tibial tubercle, allowing for a suture to be passed through the quadriceps tendon at the upper pole of the patella, which is essential for maintaining proper patellar height. Once the correct patellar height is achieved, the sutures of the infrapatellar tendon are tied off to secure the reconstruction. The procedure concludes with irrigation of the wound and closure of the incision. Additionally, if necessary, a fascial or tendon graft may be utilized to reinforce the repair, ensuring a robust reconstruction of the infrapatellar tendon.
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The procedure described by CPT® Code 27381 is indicated for the following conditions:
The surgical procedure for CPT® Code 27381 involves several critical steps to ensure effective reconstruction of the infrapatellar tendon:
Post-procedure care following the suture of the infrapatellar tendon includes monitoring for signs of infection, managing pain, and ensuring proper healing of the surgical site. Patients may be advised to follow a rehabilitation program to restore function and strength to the knee. This may involve physical therapy to gradually increase mobility and strength while protecting the surgical repair. Follow-up appointments are essential to assess the healing process and to make any necessary adjustments to the rehabilitation plan. The expected recovery time may vary based on the extent of the injury and the individual patient's healing response.
| Short Descr | REPAIR/GRAFT KNEECAP TENDON | Medium Descr | SUTR INFRAPATELLAR TDN 2 RCNSTJ W/FSCAL/TDN GRF | Long Descr | Suture of infrapatellar tendon; secondary reconstruction, including fascial or tendon graft | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P3D - Major procedure, orthopedic - other | MUE | 1 | CCS Clinical Classification | 160 - Other therapeutic procedures on muscles and tendons |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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