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The procedure described by CPT® Code 27005 refers to an open tenotomy of the hip flexor(s), which is classified as a separate procedure. A tenotomy is a surgical procedure that involves cutting a tendon to relieve tension or correct deformities. In this case, the focus is on the hip flexors, particularly the iliopsoas muscle, which is often implicated in severe flexion deformities. These deformities can arise from conditions such as spastic paraplegia or spastic cerebral palsy, where muscle tightness leads to an inability to fully extend the hip. The procedure begins with an evaluation of the flexion deformity, identifying the specific contractures that need to be addressed. The surgical approach involves making an incision over the iliopsoas tendon to expose it adequately. A complete tenotomy is then performed at the lesser trochanter, which is a bony prominence on the femur where the iliopsoas tendon attaches. In some cases, additional procedures may be necessary, such as releasing the hamstring tendons to address knee flexion deformities. This may involve incisions on the biceps femoris, semitendinosus, and/or semimembranosus tendons at the hip. After the surgical intervention, the operative incisions are meticulously closed in layers to promote healing, and casts or braces may be applied as needed to support recovery and maintain proper alignment.
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The tenotomy of the hip flexors, as described by CPT® Code 27005, is indicated for specific conditions that lead to severe flexion deformities. These conditions include:
The procedure for performing a tenotomy of the hip flexors involves several critical steps, which are outlined as follows:
Post-procedure care following a tenotomy of the hip flexors includes monitoring the surgical site for signs of infection and ensuring proper healing of the incisions. Patients may experience some discomfort and swelling, which can be managed with prescribed pain medications. Rehabilitation is a critical component of recovery, and physical therapy may be initiated to restore range of motion and strengthen the hip and knee muscles. The use of casts or braces will be determined based on the individual patient's needs and the extent of the procedure performed. Follow-up appointments will be necessary to assess healing progress and make any adjustments to the rehabilitation plan as needed.
| Short Descr | INCISION OF HIP TENDON | Medium Descr | TENOTOMY HIP FLEXOR OPEN SEPARATE PROCEDURE | Long Descr | Tenotomy, hip flexor(s), open (separate procedure) | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P3D - Major procedure, orthopedic - other | MUE | 1 | CCS Clinical Classification | 160 - Other therapeutic procedures on muscles and tendons |
| 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | LT | Left side (used to identify procedures performed on the left side of the body) | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | RT | Right side (used to identify procedures performed on the right side of the body) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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