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The procedure described by CPT® Code 27676 involves the surgical repair of dislocating peroneal tendons, specifically with the addition of a fibular osteotomy. The peroneal tendons, which include the peroneus longus and peroneus brevis, are critical structures located in the lateral compartment of the lower leg. These tendons traverse the ankle joint and are housed within a common tendon sheath, which is bordered by various anatomical structures including the fibular sulcus and ligaments. Dislocation of these tendons typically occurs due to injury to the superior retinaculum, which is responsible for maintaining their proper position. In this procedure, a more invasive approach is taken compared to CPT® Code 27675, which addresses dislocation without the need for a fibular osteotomy. The surgical intervention begins with an incision over the lateral aspect of the ankle, allowing for direct inspection of the retinaculum and the peroneal tendons. If the retinaculum is found to be insufficient to cover the tendons, additional surgical techniques may be employed, such as deepening the peroneal groove or reinforcing the retinaculum with surrounding structures like the Achilles tendon. The key distinction in CPT® Code 27676 is the performance of a fibular osteotomy, specifically a sliding distal fibular osteotomy. This involves making precise bone cuts in the distal fibula to facilitate the rotation of a bone fragment, which acts as a mechanical block to prevent the anterior displacement of the peroneal tendons. The secured bone fragment, typically fastened with screws, provides enhanced stability and reduces the likelihood of future dislocations, thereby addressing the underlying issue more effectively than simpler repair techniques.
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The procedure described by CPT® Code 27676 is indicated for patients experiencing dislocation of the peroneal tendons, which may be associated with various symptoms and conditions. The following are explicitly provided indications for this surgical intervention:
The surgical procedure for CPT® Code 27676 involves several critical steps to effectively repair the dislocating peroneal tendons with the addition of a fibular osteotomy. The following procedural steps are outlined:
After the completion of the procedure, patients can expect specific post-operative care and recovery considerations. The surgical site will require monitoring for signs of infection, swelling, and proper healing. Patients may be advised to limit weight-bearing activities on the affected ankle for a specified period to allow for adequate recovery. Physical therapy may be recommended to restore strength and range of motion in the ankle joint. Follow-up appointments will be necessary to assess the healing process and ensure that the peroneal tendons remain properly positioned. Additionally, patients should be educated on signs of potential complications, such as increased pain or instability, which may require further evaluation.
| Short Descr | REPAIR LOWER LEG TENDONS | Medium Descr | REPAIR DISLOCATING PERONEAL TENDON W/FIB OSTEOT | Long Descr | Repair, dislocating peroneal tendons; with 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) | 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) | 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. | 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). | AG | Primary physician | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | ET | Emergency services | 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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| Pre-1990 | Added | Code added. |
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