CPT® Code 27652

The Achilles tendon is recognized as the largest tendon in the human body, playing a crucial role in connecting the gastrocnemius and soleus muscles located in the calf to the calcaneus, or heel bone. This tendon is essential for various activities such as walking, running, and jumping. Over time, the Achilles tendon can become weakened and thinned due to aging or insufficient use, making it susceptible to injuries. One of the most prevalent injuries associated with the Achilles tendon is a complete tear or rupture. In the context of CPT® Code 27650, the procedure involves a suture repair of the Achilles tendon. This can be performed through an open approach, which entails making a posteromedial longitudinal skin incision over the lower leg and ankle region. The surgeon dissects the subcutaneous tissue to expose the paratenon, which is then divided longitudinally to reveal the ruptured ends of the tendon. These ends are debrided, approximated, and repaired using heavy nonabsorbable sutures. Alternatively, a percutaneous approach may be utilized, where the foot is positioned in maximal equinus, and multiple stab wounds are made over the posterior aspect of the ankle. Sutures are passed through the distal and proximal ends of the Achilles tendon, which are subsequently cut, tied off, and pushed into the subcutaneous tissue, followed by the repair of the overlying soft tissues and skin, and the application of a short leg nonweight-bearing cast. In contrast, CPT® Code 27652 specifically refers to the primary repair of a ruptured Achilles tendon using a graft, which includes the process of obtaining the graft. This grafting can be achieved through fascial augmentation using the gastrocnemius aponeurosis or the plantaris tendon. When utilizing the gastrocnemius aponeurosis, a rectangular flap measuring 1-2 cm in width and 7-8 cm in length is created and raised to within 3 cm of the rupture site. The proximal edge of this flap is then flipped distally across the rupture and sutured to the distal aspect of the rupture site. If the plantaris tendon is employed, it can be woven across the rupture site or fanned out and sutured directly to the rupture site. Both CPT® Codes 27650 and 27652 are utilized for the primary repair of the Achilles tendon, while CPT® Code 27654 pertains to secondary repairs performed when the initial repair has failed or when the tendon ruptures again, or when surgical intervention occurs several weeks post-injury.