Table of Contents

Basics of CPT code 27405, 27407 and 27409

A surgical reconstruction means that the remnant of the torn ACL/PCL is removed, and a new ligament is created with tissue from elsewhere in the body or donated from a cadaveric donor. ACL/PCL reconstruction surgery has been very successful, but there are concerns that it may not be the ideal solution for people who have injured their ACL/PCL. A repair does not require harvest of graft tissue and may provide a shorter recovery time for the patient. These procedures are done by arthroscopic or open approaches

Indications:

Chronic instability of knee
Patellar tendinitis
Spontaneous disruption of lateral collateral ligament
Spontaneous disruption of medial collateral ligament
Spontaneous disruption of posterior cruciate ligament
Sprain of anterior cruciate ligament
Sprain of medial collateral ligament or lateral collateral ligament
Sprain of posterior cruciate ligament

For a primary collateral repair (CPT code 27405), the physician makes an incision on the lateral or medial aspect of the knee, depending on which ligament is torn (medial collateral or lateral collateral). Sutures may be used to tie the torn ends together. If the attachment of the ligament to the bone is torn away, a screw may be used for fixation.

For a cruciate ligament primary repair (CPT code 27407), an incision is made to gain access into the knee joint (the physician may use the arthroscope for part of the procedure). Screws and/or sutures are used to reattach the torn end to the bone. Both collateral and cruciate ligaments are repaired in CPT code 27409. Incisions are closed with sutures, staples, and/or Steri-strips. A temporary drain may be applied.

27405    Repair, primary, torn ligament and/or capsule, knee; collateral
27407                      cruciate
27409                      collateral and cruciate ligaments

CPT code 43770-43775 Unique Coding tips for coders

Coding guide for CPT code 27427, 27428 and 27429

The physician performs an extra-articular and/or an intra-articular ligamentous reconstruction procedure of the knee. In CPT code 27427, an extra-articular augmentation is performed on one or more of the stabilizing ligaments external to the knee joint that are damaged or torn. The physician makes an incision over the affected ligament. The torn end may be attached to the bone using anchors, staples, or a screw and washer or the tear may be repaired and attached to the bone using a graft. Commonly, the patient’s own tendon is harvested to be used as the graft material.

In CPT code 27428, the physician makes an incision to access the knee joint and the ligaments within the joint. The injured ligament is identified and reattached at its torn end. If reattachment is not possible, the physician obtains a graft (such as a tendon) harvested from the patient or a donor graft, and attaches it to the original location of the ligament. In CPT code 27429, both extra- and intra-articular ligamentous reconstruction are performed. In all three methods, a temporary drain is inserted and incisions are repaired in layers with sutures, staples, and/or Steri-strips.

27427     Ligamentous reconstruction (augmentation), knee; extra-articular
27428                   intra-articular (open)
27429                   intra-articular (open) and extra-articular

Coding guide for CPT code 29888 and 29889

The physician makes a portal incision 1 cm long on either side of the inferior patella for arthroscopic access into the knee joint. If the ligament is intact but torn away from its bony attachment, the physician may reattach the ligament with a screw. If the ligament is nonfunctional, it is removed with the arthroscope. For an anterior cruciate ligament reconstruction (CPT code 29888), a 5 cm to 12 cm incision is made on the anterior lower patella and upper tibia. A tunnel is drilled through the tibia into the knee joint. A second tunnel is drilled from inside the knee joint, through the femur.

With the aid of the arthroscope for visualization, a new ligament graft is placed in the tibial tunnel and positioned inside the knee joint. The bony ends of the ligament are placed in the tibial and femoral tunnels. The ligament is secured with interference screws in both tunnels. For a posterior cruciate ligament reconstruction (CPT code 29889), an additional 3 cm to 5 cm incision is made along the medial aspect of the knee joint to allow for proper location of the femoral tunnel. Incisions are closed with staples or Steri-strips. A temporary drain may be inserted.

Reimbursement
CPT codes for ‘Anterior and Posterior Cruciate/Collateral Ligament Repair or Reconstruction’ are assigned to one of the following APC’s:
5114, Level 4 Musculoskeletal Procedures, include code(s) 27405, 27407, 27409, 27427, and 29888
5115, Level 5 Musculoskeletal Procedures, include code(s) 27428, 27429, and 29889