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The Achilles tendon is recognized as the largest tendon in the human body, playing a crucial role in connecting the gastrocnemius and soleus muscles located in the calf to the calcaneus, or heel bone. This tendon is essential for various activities such as walking, running, and jumping. Over time, the Achilles tendon can become weakened and thinned due to aging or insufficient use, making it susceptible to injuries. One of the most prevalent injuries associated with the Achilles tendon is a complete tear or rupture. In the context of CPT® Code 27650, the procedure involves a suture repair of the Achilles tendon. This can be performed through an open approach, which entails making a posteromedial longitudinal skin incision over the lower leg and ankle region. The surgeon dissects the subcutaneous tissue to expose the paratenon, which is then divided longitudinally to reveal the ruptured ends of the tendon. These ends are debrided, approximated, and repaired using heavy nonabsorbable sutures. Alternatively, a percutaneous approach may be utilized, where the foot is positioned in maximal equinus, and multiple stab wounds are made over the posterior aspect of the ankle. Sutures are passed through the distal and proximal ends of the Achilles tendon, which are subsequently cut, tied off, and pushed into the subcutaneous tissue, followed by the repair of the overlying soft tissues and skin, and the application of a short leg nonweight-bearing cast. In contrast, CPT® Code 27652 specifically refers to the primary repair of a ruptured Achilles tendon using a graft, which includes the process of obtaining the graft. This grafting can be achieved through fascial augmentation using the gastrocnemius aponeurosis or the plantaris tendon. When utilizing the gastrocnemius aponeurosis, a rectangular flap measuring 1-2 cm in width and 7-8 cm in length is created and raised to within 3 cm of the rupture site. The proximal edge of this flap is then flipped distally across the rupture and sutured to the distal aspect of the rupture site. If the plantaris tendon is employed, it can be woven across the rupture site or fanned out and sutured directly to the rupture site. Both CPT® Codes 27650 and 27652 are utilized for the primary repair of the Achilles tendon, while CPT® Code 27654 pertains to secondary repairs performed when the initial repair has failed or when the tendon ruptures again, or when surgical intervention occurs several weeks post-injury.
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The procedure associated with CPT® Code 27652 is indicated for the repair of a ruptured Achilles tendon, particularly when a graft is required to facilitate the repair. The following conditions may warrant this procedure:
The procedure for CPT® Code 27652 involves several critical steps to ensure the successful repair of the ruptured Achilles tendon using a graft. The following outlines the procedural steps:
After the procedure associated with CPT® Code 27652, the patient is typically monitored for any immediate complications. The application of a short leg nonweight-bearing cast is crucial to immobilize the ankle and promote healing of the repaired tendon. Patients are advised to avoid weight-bearing activities for a specified period, which may vary based on the surgeon's recommendations and the patient's individual healing process. Follow-up appointments are essential to assess the healing progress, and physical therapy may be initiated once the surgeon deems it appropriate to restore strength and mobility to the affected limb. Patients should be informed about signs of complications, such as increased pain, swelling, or signs of infection, and instructed to report these to their healthcare provider promptly.
| Short Descr | REPAIR/GRAFT ACHILLES TENDON | Medium Descr | RPR PRIMARY OPEN/PRQ RUPTURED ACHILLES W/GRAFT | Long Descr | Repair, primary, open or percutaneous, ruptured Achilles tendon; with graft (includes obtaining 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) | 1 - Statutory 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 | 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) | P5B - Ambulatory procedures - musculoskeletal | 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). | 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.) | 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). | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | 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 | LT | Left side (used to identify procedures performed on the left side of the body) | PO | Excepted service provided at an off-campus, outpatient, provider-based department of a hospital | RT | Right side (used to identify procedures performed on the right side of the body) | 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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