How To Use CPT Code 27386

CPT 27386 describes the procedure for the secondary reconstruction of a quadriceps or hamstring muscle tear, including the use of a graft from a tendon or fascia. 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 27386?

CPT 27386 can be used to describe the secondary reconstruction of a quadriceps or hamstring muscle tear. This procedure involves repairing the torn muscle at least a few days after the initial rupture or when the initial repair is not satisfactory. The provider uses a graft from a tendon or the patient’s fascia to reinforce the repair of the ruptured muscle.

2. Official Description

The official description of CPT code 27386 is: ‘Suture of quadriceps or hamstring muscle rupture; secondary reconstruction, including fascial or tendon graft.’

3. Procedure

1. The provider makes an incision in the skin of the thigh over the torn quadriceps or hamstring muscle.
2. They dissect down through the subcutaneous tissue to access the torn muscle.
3. The provider brings the two ends of the muscle closer together and sutures them.
4. They obtain a tendon or fascial graft from a surrounding muscle and use it to reinforce the repair of the ruptured muscle.
5. Hemostasis is achieved at the surgical site, and the wound is closed by suturing the soft tissue in layers.

4. Qualifying circumstances

CPT 27386 is used for the secondary reconstruction of a quadriceps or hamstring muscle tear. This procedure is performed when the initial repair is not satisfactory or when the provider repairs the torn muscle at least a few days after the initial rupture. The use of a graft from a tendon or fascia is also a qualifying circumstance for this code.

5. When to use CPT code 27386

CPT code 27386 should be used when the provider performs the secondary reconstruction of a quadriceps or hamstring muscle tear, including the use of a graft from a tendon or fascia. This code should not be used for primary repair of a muscle rupture, which is represented by CPT code 27385.

6. Documentation requirements

To support a claim for CPT 27386, the provider must document the following information:

• Patient’s diagnosis of a quadriceps or hamstring muscle tear
• Reason for performing the secondary reconstruction
• Description of the graft used (tendon or fascia)
• Date of the procedure
• Details of the surgical technique used
• Any complications encountered during the procedure
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 27386, ensure that the procedure performed is the secondary reconstruction of a quadriceps or hamstring muscle tear, including the use of a graft from a tendon or fascia. This code should not be reported with CPT codes 27366 to 27375, which represent primary repair of muscle ruptures. It is important to accurately document the procedure and provide any necessary supporting documentation to justify the use of this code.

8. Historical information

CPT 27386 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A provider performs the secondary reconstruction of a quadriceps muscle tear using a tendon graft.
2. A patient undergoes the secondary reconstruction of a hamstring muscle tear with a fascial graft.
3. A provider repairs a quadriceps muscle tear that was not satisfactorily repaired during the initial procedure, using a tendon graft.
4. A patient with a hamstring muscle tear undergoes the secondary reconstruction with a fascial graft due to the failure of the initial repair.
5. A provider performs the secondary reconstruction of a quadriceps muscle tear using a tendon graft after a few days of the initial rupture.
6. A patient undergoes the secondary reconstruction of a hamstring muscle tear with a fascial graft to reinforce the repair.
7. A provider repairs a quadriceps muscle tear that was not satisfactorily repaired during the initial procedure, using a tendon graft and reinforcing the repair with a fascial graft.
8. A patient with a hamstring muscle tear undergoes the secondary reconstruction with a fascial graft to reinforce the repair after a few days of the initial rupture.
9. A provider performs the secondary reconstruction of a quadriceps muscle tear using a tendon graft and reinforcing the repair with a fascial graft.
10. A patient undergoes the secondary reconstruction of a hamstring muscle tear with a fascial graft to reinforce the repair after the initial repair was not satisfactory.