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The procedure described by CPT® Code 27675 involves the surgical repair of dislocating peroneal tendons without the need for a fibular osteotomy. The peroneal tendons, specifically the peroneus longus and peroneus brevis, are critical structures located in the lateral compartment of the lower leg. These tendons originate before crossing the ankle joint and are housed within a common tendon sheath. The anatomical positioning of these tendons is supported by various structures, including the fibular sulcus anteriorly, the calcaneofibular and posterior tibiofibular ligaments medially, and the superior retinaculum posterolaterally. As the tendons progress distally past the fibula, they are separated by the peroneal tubercle, entering distinct tendon sheaths. The peroneus brevis tendon inserts at the base of the fifth metatarsal, while the peroneus longus tendon traverses the plantar aspect of the foot to insert on the first metatarsal. The peroneal groove, located on the posterior surface of the lateral malleolus and covered by fibrocartilage, plays a vital role in maintaining the proper positioning of the peroneal tendons. Dislocation of these tendons typically occurs due to an injury to the superior retinaculum, which can compromise the stability of the tendons. In the surgical procedure associated with CPT® Code 27675, an incision is made on the lateral side of the ankle to access the retinaculum and the tendons. The surgeon inspects the retinaculum to assess whether it can adequately cover the tendons after they are repositioned back into the peroneal groove. The retinaculum is then sutured over the tendons to secure them in place. In certain cases, the procedure may involve deepening the peroneal groove to further prevent future dislocations. Alternative repair techniques may include reinforcing the retinaculum with the Achilles tendon, rerouting the tendons using the calcaneofibular ligament, or utilizing a portion of the external lateral ligament for repair. This procedure is distinct from CPT® Code 27676, which involves a more invasive approach, including a bone block procedure with a sliding distal fibular osteotomy to mechanically stabilize the tendons.
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The procedure associated with CPT® Code 27675 is indicated for patients experiencing dislocation of the peroneal tendons, which may result from trauma or injury to the superior retinaculum. This condition can lead to pain, instability, and functional impairment in the ankle and foot. The surgical intervention aims to restore the normal anatomical position of the tendons and prevent future dislocations, thereby improving the patient's mobility and overall quality of life.
The surgical procedure for CPT® Code 27675 involves several critical steps to ensure the successful repair of the dislocating peroneal tendons. Initially, the surgeon makes an incision over the lateral aspect of the ankle to gain access to the peroneal tendons and the retinaculum. This incision allows for a clear view of the anatomical structures involved in the procedure.
After the completion of the procedure associated with CPT® Code 27675, patients typically require a period of recovery that may involve immobilization of the ankle to allow for proper healing. Post-operative care may include pain management, physical therapy, and gradual reintroduction of weight-bearing activities as tolerated. The surgeon will provide specific instructions regarding activity restrictions and rehabilitation protocols to ensure optimal recovery and prevent complications. Follow-up appointments are essential to monitor the healing process and assess the stability of the repaired tendons.
| Short Descr | REPAIR LOWER LEG TENDONS | Medium Descr | RPR DISLOC PERONEAL TENDON W/O FIBULAR OSTEOTOMY | Long Descr | Repair, dislocating peroneal tendons; without fibular osteotomy | 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 |
| 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). | 81 | Minimum assistant surgeon: minimum surgical assistant services are identified by adding modifier 81 to the usual procedure number. | 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). | 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) | RT | Right side (used to identify procedures performed on the right side of the body) | SG | Ambulatory surgical center (asc) facility service | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | 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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