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The procedure described by CPT® Code 27394 involves the lengthening of multiple hamstring tendons in one leg. 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 key muscles: the biceps femoris, semitendinosus, and semimembranosus, which play crucial roles in extending the knee and flexing the thigh. The lengthening of these tendons aims to correct the muscle imbalance, thereby improving the patient's gait and overall mobility. The procedure is more extensive than the lengthening of a single tendon, as indicated by CPT® Code 27393, which addresses the lengthening of one hamstring tendon. The surgical approach involves making an incision in the popliteal crease, exposing the tendon, and performing a Z-shaped incision to facilitate the lengthening process. This technique allows the tendon fibers to slide apart as the knee is extended, ultimately leading to a more functional range of motion. Following the procedure, the tendon is secured in its lengthened position with sutures, and a long leg or cylinder cast is applied to maintain the knee in an extended position during the recovery phase.
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The lengthening of hamstring tendons is performed for specific indications related to muscle imbalances and gait abnormalities. The following conditions are explicitly mentioned as indications for this procedure:
The procedure for lengthening multiple hamstring tendons in one leg involves several critical steps to ensure effective surgical intervention. Each step is detailed as follows:
Post-procedure care following the lengthening of multiple hamstring tendons is essential for optimal recovery. Patients are typically required to keep the leg immobilized in the cast for a specified duration to ensure that the tendons heal properly in their lengthened state. During this recovery period, regular follow-up appointments are necessary to monitor healing progress and assess any potential complications. Physical therapy may be recommended after the cast is removed to help restore strength, flexibility, and function to the affected leg. The overall goal of post-procedure care is to enhance mobility and improve the patient's gait, addressing the underlying issues that prompted the surgical intervention.
| Short Descr | LENGTHENING OF THIGH TENDONS | Medium Descr | LENGTHENING HAMSTRING TENDON MULTIPLE 1 LEG | Long Descr | Lengthening of hamstring tendon; 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) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | 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) | P3D - Major procedure, orthopedic - other | 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. | 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). | RT | Right side (used to identify procedures performed on the right side of the body) | 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) | 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. | 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). | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| 2010-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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