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Official Description

Tenotomy, hip flexor(s), open (separate procedure)

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

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.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

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:

  • Spastic Paraplegia A neurological condition characterized by muscle stiffness and spasms, leading to difficulty in movement and posture.
  • Spastic Cerebral Palsy A group of disorders affecting movement and muscle tone, often resulting in tightness and contractures in the hip flexors.

2. Procedure

The procedure for performing a tenotomy of the hip flexors involves several critical steps, which are outlined as follows:

  • Step 1: Evaluation of Flexion Deformity The surgeon begins by thoroughly evaluating the patient's hip flexion deformity to determine the extent of the contracture and the specific muscles involved. This assessment is crucial for planning the surgical approach and ensuring that all necessary tendons are addressed during the procedure.
  • Step 2: Incision Over the Iliopsoas Tendon Once the evaluation is complete, the surgeon makes an incision in the skin over the iliopsoas tendon. This incision is strategically placed to provide optimal access to the tendon while minimizing damage to surrounding tissues.
  • Step 3: Exposure of the Iliopsoas Tendon After the incision is made, the surgeon carefully dissects the tissue to expose the iliopsoas tendon. This step requires precision to ensure that the tendon is adequately visualized for the tenotomy.
  • Step 4: Performing the Tenotomy With the tendon exposed, the surgeon performs a complete tenotomy at the lesser trochanter. This involves cutting the tendon to release the tension that contributes to the flexion deformity, allowing for improved range of motion in the hip.
  • Step 5: Release of Hamstring Tendons (if necessary) In cases where knee flexion deformities are also present, the surgeon may proceed to release the hamstring tendons. This involves making incisions on the biceps femoris, semitendinosus, and/or semimembranosus tendons at the hip to further alleviate contractures and improve overall mobility.
  • Step 6: Closure of Operative Incisions After completing the necessary tendon releases, the surgeon meticulously closes the operative incisions in layers. This layered closure technique is essential for promoting optimal healing and minimizing the risk of complications.
  • Step 7: Application of Casts or Braces Following the closure, the surgeon may apply casts or braces as needed to support the hip and knee during the recovery process. These devices help maintain proper alignment and prevent excessive movement while the tissues heal.

3. Post-Procedure

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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