How To Use CPT Code 27385

CPT 27385 describes the primary suture of a hamstring or quadriceps muscle rupture to relieve pain and restore proper gait. 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 27385?

CPT 27385 can be used to describe the primary suture of a hamstring or quadriceps muscle rupture. This procedure is performed to alleviate pain and restore normal walking patterns. The provider makes an incision over the site of the muscle rupture, debrides the torn ends of the muscles, and sutures the healthy muscle tissue together. This helps to promote healing and improve the patient’s mobility.

2. Official Description

The official description of CPT code 27385 is: ‘Suture of quadriceps or hamstring muscle rupture; primary.’

3. Procedure

1. The provider prepares the patient for the procedure and administers anesthesia.
2. An incision is made over the site of the muscle rupture.
3. The torn ends of the muscles are debrided to remove any damaged or unhealthy tissue.
4. The provider carefully sutures the healthy muscle tissue together, ensuring proper alignment and tension.
5. Hemostasis is achieved to control bleeding from the incision and suture lines.
6. The incision is closed with sutures and staples to complete the procedure.

4. Qualifying circumstances

CPT 27385 is performed on patients who have experienced a primary rupture of the hamstring or quadriceps muscles. This typically occurs due to injury or trauma. The procedure is intended to relieve pain and restore proper gait. It is important to note that this code represents a unilateral service, meaning it is performed on one leg. If the provider performs the procedure on both legs, modifiers 50, RT, and LT may be appended based on payer preference.

5. When to use CPT code 27385

CPT code 27385 should be used when the provider performs the primary suture of a hamstring or quadriceps muscle rupture. This code is not appropriate for secondary reconstructions or grafts. If the provider sutures a secondary rupture, CPT code 27386 should be used instead. It is important to accurately document the details of the procedure to support the use of this code.

6. Documentation requirements

To support a claim for CPT 27385, the provider must document the following information:

• Patient’s diagnosis and indication for the procedure
• Details of the procedure, including the specific muscles involved and the approach used
• Incision site and size
• Description of the debridement process
• Type of sutures used and the number of sutures applied
• Confirmation of hemostasis
• Method of closure (sutures, staples, etc.)

7. Billing guidelines

When billing for CPT 27385, ensure that the procedure performed is the primary suture of a hamstring or quadriceps muscle rupture. This code should not be reported with other codes for secondary reconstructions or grafts. It is important to follow payer guidelines regarding the use of modifiers, such as modifier 50 for bilateral procedures or modifiers RT and LT for procedures performed on both legs. Accurate and detailed documentation is essential for proper billing and reimbursement.

8. Historical information

CPT 27385 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 sustains a hamstring muscle rupture during a sports activity. The provider performs the primary suture of the muscle to alleviate pain and restore function.
2. An individual experiences a quadriceps muscle rupture due to a fall. The provider performs the primary suture of the muscle to promote healing and improve mobility.
3. A patient presents with a hamstring muscle rupture following a car accident. The provider performs the primary suture of the muscle to relieve pain and facilitate rehabilitation.
4. An athlete suffers a quadriceps muscle rupture during a game. The provider performs the primary suture of the muscle to enable the patient to return to their sport.
5. A person injures their hamstring muscle while exercising. The provider performs the primary suture of the muscle to aid in the recovery process and prevent further complications.
6. A patient experiences a quadriceps muscle rupture during a fall. The provider performs the primary suture of the muscle to restore strength and function.
7. An individual sustains a hamstring muscle rupture during a dance performance. The provider performs the primary suture of the muscle to alleviate pain and facilitate rehabilitation.
8. A person suffers a quadriceps muscle rupture while lifting weights. The provider performs the primary suture of the muscle to promote healing and improve mobility.
9. An athlete sustains a hamstring muscle rupture during a game. The provider performs the primary suture of the muscle to enable the patient to return to their sport.
10. A patient injures their quadriceps muscle while running. The provider performs the primary suture of the muscle to aid in the recovery process and prevent further complications.