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The procedure described by CPT® Code 27429 refers to ligamentous reconstruction (augmentation) of the knee, which involves both intra-articular and extra-articular techniques. The knee joint is stabilized by four major ligaments: the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the medial collateral ligament (MCL), and the lateral collateral ligament (LCL). The ACL and PCL are crucial for the stability of the knee, connecting the femur to the tibia, while the MCL and LCL provide additional support on the inner and outer aspects of the knee, respectively. Although the MCL and LCL are less frequently injured, they may require surgical intervention in certain cases. In this procedure, intra-articular reconstruction focuses on repairing or augmenting the ACL or PCL by accessing the joint capsule directly. This involves incising the joint capsule, inspecting the damaged ligament, and removing it if necessary. The extra-articular component of the procedure utilizes structures outside the joint to provide additional reinforcement to the knee's stability. Techniques such as tightening the iliotibial tract may be employed to prevent lateral movement of the knee, although these extra-articular procedures are not commonly performed. The reconstruction process may involve harvesting graft material, such as the central third of the patellar tendon, which is then used to replace the damaged ligament. The procedure is intricate, requiring precise drilling and placement of grafts to ensure proper alignment and stability of the knee joint post-surgery. This combined approach allows for a comprehensive treatment of ligamentous injuries, addressing both intra-articular and extra-articular stabilization needs.
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The procedure described by CPT® Code 27429 is indicated for patients with significant ligamentous injuries to the knee that require surgical intervention. The following conditions may warrant this procedure:
The procedure for ligamentous reconstruction (augmentation) of the knee using CPT® Code 27429 involves several detailed steps to ensure effective repair of the damaged ligaments. The following procedural steps are typically performed:
After the ligamentous reconstruction procedure, patients typically undergo a structured rehabilitation program to promote healing and restore function. Post-procedure care may include pain management, physical therapy, and gradual weight-bearing exercises as tolerated. The expected recovery time can vary based on the extent of the surgery and the individual's overall health. Regular follow-up appointments are essential to monitor the healing process and ensure that the knee regains strength and stability. Patients are advised to adhere to their rehabilitation protocols to optimize outcomes and minimize the risk of complications.
| Short Descr | RECONSTRUCTION KNEE | Medium Descr | LIGMOUS RCNSTJ AGMNTJ KNE INTRA-ARTICULAR XTR | Long Descr | Ligamentous reconstruction (augmentation), knee; intra-articular (open) and extra-articular | 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 | 152 - Arthroplasty knee |
| 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). | 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. | 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.) | 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 | 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) |
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| 2011-01-01 | Changed | Short description changed. |
| Pre-1990 | Added | Code added. |
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