How To Use CPT Code 27425

CPT 27425 describes a surgical procedure that involves the incision or division of the lateral retinaculum, a fibrous tissue on the outer side of the knee. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 27425?

CPT 27425 is a code used to describe a surgical procedure that involves the incision or division of the lateral retinaculum, a band of fibrous tissue on the outer side of the knee. This procedure is typically performed to treat patellar subluxation or partial dislocation.

2. Official Description

The official description of CPT code 27425 is: ‘Lateral retinacular release, open.’ It is important to note that for arthroscopic lateral release, a different code, 29873, should be used.

3. Procedure

1. The provider makes an incision in the skin on the outer side of the knee cap.
2. They dissect through the soft tissue to expose the fibrous bands that cover the patella on the outer side.
3. The provider then cuts the fibrous tissue along its length to reduce the excessive outward pull on the patella.
4. Hemostasis is achieved at the surgical site, and the wound is closed by suturing the soft tissue in layers.

4. Qualifying circumstances

CPT 27425 is typically performed to treat patellar subluxation or partial dislocation. The procedure is indicated when the lateral retinaculum becomes tight, causing the patella to tilt on one side and resulting in pain in the front of the knee.

5. When to use CPT code 27425

CPT code 27425 should be used when the provider performs an open lateral retinacular release procedure. It is important to note that for arthroscopic lateral release, a different code, 29873, should be used.

6. Documentation requirements

To support a claim for CPT 27425, the provider must document the following information:

• Patient’s diagnosis indicating the need for a lateral retinacular release
• Description of the procedure performed
• Date of the procedure
• Details of the incision and division of the lateral retinaculum
• Any additional procedures performed during the same surgical session
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 27425, ensure that the procedure performed is an open lateral retinacular release. It is important to use the correct code based on the specific procedure performed, as arthroscopic lateral release should be reported with code 29873. Additionally, consider any applicable modifiers and follow the appropriate coding guidelines for accurate billing.

8. Historical information

CPT 27425 was added to the Current Procedural Terminology system on January 1, 1990. There have been a few changes to the code over the years, with the most recent change occurring on January 1, 2004, when the description was updated to specify ‘open’ lateral retinacular release.

9. Examples

1. A patient undergoes an open lateral retinacular release to treat patellar subluxation.
2. A provider performs a lateral retinacular release procedure to address partial dislocation of the patella.
3. An individual with a tight lateral retinaculum undergoes an open release procedure to alleviate knee pain.
4. A lateral retinacular release is performed on a patient with patellar instability.
5. A provider performs an open procedure to release the lateral retinaculum and improve patellar alignment in a patient.
6. A lateral retinacular release is performed to address patellar maltracking in a patient.
7. An individual undergoes an open release procedure to correct lateral patellar tilt.
8. A provider performs a lateral retinacular release to alleviate pain and improve knee function in a patient.
9. A lateral retinacular release is performed on a patient with recurrent patellar dislocation.
10. An individual undergoes an open procedure to release the tight lateral retinaculum and improve patellar stability.