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Hamstring tenotomy is a surgical procedure aimed at addressing flexion deformities of the knee, which can significantly impact mobility and function. The hamstring group consists of three primary muscles: the biceps femoris, semitendinosus, and semimembranosus. These muscles play a crucial role in extending the knee and flexing the thigh, making them essential for various movements such as walking, running, and jumping. In the context of CPT® Code 27391, the procedure involves an open tenotomy, which is a surgical intervention where multiple tendons of the hamstring are divided in one leg. This is particularly relevant for patients who may have tightness or contractures in these muscles, leading to difficulties in straightening the knee. The procedure is performed through an incision made in the popliteal crease, allowing for direct access to the tendon insertion site on the tibia. Following the division of the tendons, a long leg or cylinder cast is applied to maintain the knee in an extended position, facilitating proper healing and recovery. This code is specifically designated for cases where multiple tendons are involved, distinguishing it from other related codes that address single tendon interventions.
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Hamstring tenotomy is indicated for patients experiencing flexion deformities of the knee, which may result from conditions such as muscle tightness, contractures, or other musculoskeletal issues that limit the ability to fully extend the knee. This procedure is particularly relevant for individuals who have undergone previous surgeries or treatments that may have affected the normal function of the hamstring muscles, leading to impaired mobility.
The procedure for an open hamstring tenotomy involves several critical steps to ensure successful tendon division and patient recovery. Initially, the patient is positioned appropriately to allow access to the knee area. The surgeon makes an incision in the popliteal crease, which is located at the back of the knee, directly over the tendon insertion site on the tibia. This strategic placement of the incision facilitates optimal exposure of the hamstring tendons. Once the incision is made, the surrounding soft tissues are carefully dissected to reveal the tendons that need to be divided. The surgeon then identifies the specific tendons involved, which may include the biceps femoris, semitendinosus, and semimembranosus. After confirming the correct tendons, the surgeon proceeds to incise and divide each tendon as necessary. This division is crucial for alleviating the tightness and restoring the knee's range of motion. Following the completion of the tendon division, a long leg or cylinder cast is applied to the affected leg, ensuring that the knee remains in an extended position during the healing process. This immobilization is essential for proper recovery and to prevent complications.
After the hamstring tenotomy procedure, patients are typically monitored for any immediate complications related to the surgery. The application of a long leg or cylinder cast is crucial, as it helps to immobilize the knee in an extended position, which is necessary for proper healing of the divided tendons. Patients may experience some discomfort and swelling in the initial days following the surgery, which can be managed with prescribed pain relief medications. Rehabilitation and physical therapy are often recommended to gradually restore strength and flexibility to the knee and hamstring muscles. The duration of recovery may vary depending on the individual’s overall health and adherence to post-operative care instructions. Regular follow-up appointments are essential to monitor the healing process and to make any necessary adjustments to the rehabilitation plan.
| Short Descr | INCISION OF THIGH TENDONS | Medium Descr | TENOTOMY OPN HAMSTRING KNEE HIP MULTIPLE 1 LEG | Long Descr | Tenotomy, open, hamstring, knee to hip; multiple tendons, 1 leg | 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) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies 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 | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5B - Ambulatory procedures - musculoskeletal | MUE | 1 | CCS Clinical Classification | 160 - Other therapeutic procedures on muscles and tendons |
| RT | Right side (used to identify procedures performed on the right side of the body) | 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). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | LT | Left side (used to identify procedures performed on the left side of the body) | 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. | 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. | 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). | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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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| 2010-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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