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The procedure described by CPT® Code 27393 involves the lengthening of a single hamstring tendon. This surgical intervention is primarily indicated for patients suffering from conditions such as spastic cerebral palsy, meningomyelocele, or other neurological disorders that lead to muscle imbalances, particularly resulting in a flexed-knee gait. The hamstring group consists of three muscles: the biceps femoris, semitendinosus, and semimembranosus, which play crucial roles in extending the knee and flexing the thigh. In this specific procedure, the surgeon makes an incision in the popliteal crease, which is the area behind the knee, to access the tendon insertion site on the tibia. The surgical technique involves creating a Z-shaped incision in the tendon, which facilitates lengthening by allowing the tendon fibers to separate as the knee is extended. After the tendon is lengthened, sutures are placed to secure it in the new, elongated position. To ensure proper healing and alignment, a long leg or cylinder cast is applied with the knee in an extended position. This procedure is distinct from other related codes, such as CPT® 27394, which is used for lengthening multiple hamstring tendons in one leg, and CPT® 27395, which is for lengthening multiple tendons in both legs.
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The lengthening of a hamstring tendon, as described by CPT® Code 27393, is indicated for specific medical conditions that result in muscle imbalances and functional impairments. The following conditions are explicitly mentioned as indications for this procedure:
The procedure for lengthening a single hamstring tendon involves several critical steps to ensure successful outcomes. The following procedural steps are outlined:
Post-procedure care following the lengthening of a hamstring tendon is vital for optimal recovery. Patients are typically monitored for any signs of complications, and pain management strategies are implemented as needed. The application of a long leg or cylinder cast helps to stabilize the knee in an extended position, which is crucial for the healing of the tendon. Patients may be advised on rehabilitation exercises to gradually restore mobility and strength once the initial healing phase is complete. Follow-up appointments are essential to assess the healing process and to make any necessary adjustments to the treatment plan.
| Short Descr | LENGTHENING OF THIGH TENDON | Medium Descr | LENGTHENING HAMSTRING TENDON SINGLE | Long Descr | Lengthening of hamstring tendon; single tendon | 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 | 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 |
| 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. | RT | Right side (used to identify procedures performed on the right side of the body) | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 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). | 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). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | LT | Left side (used to identify procedures performed on the left side of the body) |
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