How To Use CPT Code 27691

CPT 27691 describes the transfer or transplant of a single deep tendon in the foot to restore function lost due to a diseased, paralyzed, or injured tendon. 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 27691?

CPT 27691 can be used to describe a surgical procedure in which a single deep tendon in the foot is transferred or transplanted to restore lost function caused by a diseased, paralyzed, or injured tendon. This code is used when the provider performs the transfer or transplant surgery on one of the tendons in the foot.

2. Official Description

The official description of CPT code 27691 is: ‘Transfer or transplant of single tendon (with muscle redirection or rerouting); deep (eg, anterior tibial or posterior tibial through interosseous space, flexor digitorum longus, flexor hallucis longus, or peroneal tendon to midfoot or hindfoot).’

3. Procedure

1. The provider begins by making a long incision on the front of the lower leg to the forefoot, exposing the diseased tendon while avoiding damage to the nerves.
2. The diseased portion of the tendon is carefully excised.
3. The provider then exposes the healthy flexor digitorum longus (FDL) tendon from the ankle to deep in the sole of the foot.
4. The healthy FDL tendon is divided and harvested.
5. A drill hole is made in the navicular bone.
6. The harvested tendon is carefully prepared and rerouted through the drill hole in the navicular bone.
7. The foot is positioned correctly, and the patient is asked to move their foot to ensure the correct length and tension of the tendon.
8. The tendon is sutured in place.
9. Any bleeding is controlled, and the wounds are closed.
10. The foot is placed in a half leg walking cast for two to six weeks.

4. Qualifying circumstances

CPT 27691 is performed on patients who require the transfer or transplant of a single deep tendon in the foot to restore lost function. This procedure is typically done when the patient has a diseased, paralyzed, or injured tendon. The specific tendon being transferred or transplanted may vary depending on the patient’s condition and the provider’s assessment.

5. When to use CPT code 27691

CPT code 27691 should be used when a provider performs a transfer or transplant surgery on a single deep tendon in the foot. This code is appropriate when the procedure involves redirecting or rerouting the tendon to restore lost function. It is important to note that this code should not be used for multiple tendon transfers or transplants.

6. Documentation requirements

To support a claim for CPT 27691, the provider must document the following information:

• Patient’s diagnosis and the need for the tendon transfer or transplant
• Details of the specific tendon being transferred or transplanted
• Date of the surgery
• Specific steps taken during the procedure, including any muscle redirection or rerouting
• Length of the incision and any complications encountered
• Post-operative care instructions and any follow-up appointments scheduled
• Signature of the provider performing the surgery

7. Billing guidelines

When billing for CPT 27691, ensure that the procedure involves the transfer or transplant of a single deep tendon in the foot. This code should not be reported with additional codes for primary procedures. It is important to follow the guidelines set by the payer regarding the use of modifier 62 if the provider is acting as a cosurgeon with another provider. Medicare and most other payers reimburse procedures coded with modifier 62 at 125 percent of the regular fee schedule amount.

8. Historical information

CPT 27691 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 a transfer of the anterior tibial tendon to the midfoot to restore function in a patient with a diseased tendon.
2. A provider transplants the flexor digitorum longus tendon to the hindfoot to restore function in a patient with a paralyzed tendon.
3. A provider transfers the flexor hallucis longus tendon through the interosseous space to the midfoot to restore function in a patient with an injured tendon.