How To Use CPT Code 27097

CPT 27097 describes the release or recession of the hamstring muscle at its upper end, which is located on the back of the thigh. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 27097?

CPT 27097 can be used to describe the procedure in which the provider releases or recesses the hamstring muscle at its upper end. The hamstring consists of three muscles: biceps femoris, semitendinosus, and semimembranosus. These muscles extend from the pelvis to the knee at the back of the thigh and are responsible for flexing or bending the knee and extending the hip. The purpose of this procedure is to break adhesions and scars formed over the muscle, allowing the muscle tendon to glide freely over the joint.

2. Official Description

The official description of CPT code 27097 is: ‘Release or recession, hamstring, proximal.’

3. Procedure

1. The provider makes an incision in the skin of the hip over the proximal end of the hamstring muscle to be released.
2. They dissect through the subcutaneous tissue to gain adequate exposure of the muscle.
3. Adhesions and scars formed over the muscle are broken and debrided.
4. Cuts may be made in the muscles to lengthen them, allowing the muscle tendon to glide freely over the joint.
5. Hemostasis is obtained at the surgical site, and the wound is closed by suturing the soft tissue in layers.

4. Qualifying circumstances

CPT 27097 is performed on patients who have adhesions or scars formed over the hamstring muscle, causing restricted movement and discomfort. The procedure is typically indicated when conservative treatments, such as physical therapy or medication, have failed to provide relief. It is important to note that this procedure specifically targets the proximal end of the hamstring muscle.

5. When to use CPT code 27097

CPT code 27097 should be used when the provider performs a release or recession of the hamstring muscle at its upper end. It is important to ensure that the procedure is performed on the proximal end of the muscle and not on other parts of the hamstring. This code should not be used for procedures involving other muscles or different locations.

6. Documentation requirements

To support a claim for CPT 27097, the provider must document the following information:

• Indication for the procedure, including the presence of adhesions or scars over the hamstring muscle
• Description of the procedure performed, including the specific techniques used
• Date of the procedure
• Any complications or unexpected findings
• Post-procedure instructions or recommendations
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 27097, ensure that the procedure performed is a release or recession of the hamstring muscle at its upper end. It is important to accurately document the details of the procedure and any associated complications or unexpected findings. CPT code 27097 should not be reported with other codes unless additional procedures were performed during the same session and are separately identifiable.

8. Historical information

CPT 27097 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient with chronic hamstring tightness undergoes a release of the hamstring muscle at its upper end to improve flexibility and reduce discomfort.
2. An athlete with a history of hamstring strains undergoes a recession of the hamstring muscle to prevent future injuries and improve performance.
3. A patient with limited range of motion in the hip and knee undergoes a release of the hamstring muscle to restore normal movement.
4. A patient with hamstring adhesions following a previous surgery undergoes a release of the scar tissue to alleviate pain and improve function.
5. A patient with hamstring contractures undergoes a recession of the muscle to increase flexibility and improve mobility.
6. A patient with hamstring tightness and associated lower back pain undergoes a release of the hamstring muscle to relieve tension and improve overall function.
7. An individual with a history of hamstring strains undergoes a recession of the muscle to reduce the risk of future injuries during physical activities.
8. A patient with hamstring adhesions following a traumatic injury undergoes a release of the scar tissue to restore normal muscle function and range of motion.
9. An athlete with hamstring tightness undergoes a recession of the muscle to improve performance and prevent muscle imbalances.
10. A patient with chronic hamstring pain undergoes a release of the muscle to alleviate discomfort and improve daily activities.