CPT Code 27650 is used for the primary surgical repair of a complete Achilles tendon rupture.
You might have heard about Achilles heel in the Trojan War. No one was there to help him. But as a provider, you can help if someone has an Achilles tendon. However, the challenge is accurate medical billing after the procedure. The real problem is using the accurate code for this procedure which is CPT 27650.
In this guide, I will tell you all about CPT code 27650, its correct use, modifiers, when to use the CPT code, and orthopedic billing mistakes when using the code.
The CPT Code 27650 is used when surgery is performed as a primary procedure. In easy words, it is a universal code doctors and coders use when a patient tears their Achilles tendon and needs surgery to fix it.
The key term here is primary repair. Doctor should use the CPT 27650 when the tendon is fixed soon after the injury, often within the first days or weeks. This means the surgeon brings the torn tendon ends together and stitches them to restore strength.
Pro Tip: CPT code 27650 should not be confused with CPT 27652, which is for secondary repair or reconstruction.
What is the difference between CPT 27650 and CPT 27652?
CPT 27650 is used for a primary Achilles tendon repair, meaning it’s the first surgery to fix a fresh rupture. CPT 27652 is used when the tendon needs a secondary repair or reconstruction, often for old, chronic, or previously treated tears that require more complex surgical work.
Use CPT 27650 only when:
- The repair is primary.
- The tendon ends are healthy enough to bring together.
Do not use CPT 27650 if:
- The surgery is a revision.
- A graft, transfer, or reconstruction is performed.
- The procedure is only a debridement for a partial tear.
When is CPT Code 27650 Used?
CPT 27650 is most often used in cases of sudden rupture of the Achilles tendon. The Achilles is the strongest tendon in the body, but it can snap under stress.
Clinical Indications for healthcare providers:
- Sports injuries, like basketball or soccer players pushing off hard.
- Trauma, such as a fall or a direct blow.
- Middle-aged adults who return to sports without training.
- Sudden stress in weakened tendons due to aging or steroids.
Example Scenarios of Using CPT Code 27650
Sports Injury
A 35-year-old man is playing tennis and makes a quick push-off to reach the ball. He suddenly hears a loud “pop” and feels as if someone kicked him in the back of the ankle. He falls and cannot continue the game. At the hospital, imaging confirms a complete rupture. The surgeon performs a primary repair, and CPT 27650 is used when the doctor prepares medical bills.
Fall at Home
A 50-year-old woman misses a step while carrying laundry and falls awkwardly. She feels sharp pain in the back of her lower leg and struggles to walk. After an MRI, her doctor finds a full tear of the Achilles tendon. Since this is her first rupture and the tendon can be directly repaired, the correct billing code is CPT 27650.
Athletic Training Accident
A 40-year-old runner is doing sprint drills during practice. As he takes off for a fast run, he feels a sudden snap in his calf and collapses. He describes the sensation as though someone struck him from behind. The exam shows loss of tendon function and swelling. The orthopedic surgeon schedules surgery, and CPT 27650 is billed for the primary repair.
When CPT 27650 is Not Used?
As a provider, you should remember. Don’t use the said CPT code every time. Here are some situations:
Not for partial tears
Sometimes the tendon is only partly torn. In such cases, the orthopedic surgeon may simply clean up or trim the damaged portion through a procedure called debridement. Since no full repair is being done, CPT 27650 does not fit here. A more accurate code must be chosen to reflect what was actually performed.
Not for revision cases
If a patient had a prior Achilles surgery that failed or if the tendon re-ruptures later, this no longer counts as a primary repair. These cases often require more complex work, sometimes involving grafts or tendon transfers. For such secondary or reconstructive repairs, CPT 27652 is the correct choice, not 27650.
Not for chronic conditions without rupture
Some patients suffer from ongoing tendonitis, heel pain, or degeneration of the tendon over time, but without a complete tear. For these conditions, CPT 27650 is not valid since there is no full rupture to repair. Other codes tied to debridement, lengthening, or different tendon procedures will apply instead.
In short, CPT 27650 is used for fresh, complete ruptures that require a primary surgical fix.
Medical Billing Guidelines for Using CPT 27650
Billing CPT 27650 requires attention to payer rules, global surgical periods, and proper documentation.
Global Surgical Period
CPT 27650 usually carries a 90-day global surgical period. This means post-op visits and routine follow-ups within 90 days are included in the payment and cannot be billed separately.
Payer Considerations
Most payers cover this code if documentation supports medical necessity. That includes the operative note, diagnosis code (like S86.011A – Rupture of right Achilles tendon, initial encounter), and proof of a complete tear.
Medicare Coverage
Medicare recognizes CPT 27650, but proper ICD-10 linkage is key. Pairing it with vague codes like “ankle pain” may lead to denial. Linking it with the rupture code is essential.
Common Orthopedic Billing Mistakes to Avoid
As an orthopedic surgeon, you should be careful when preparing medical bills. Otherwise, you will have to wait, wait, and wait for medical claims to be accepted. However, keep these points in your mind.
- 27650 code is only for a first-time Achilles tendon repair.
- Using it for a revision or secondary repair will be denied.
- If the surgeon’s note does not say “primary repair,” the claim may get rejected.
- Linking it to arthritis, chronic pain, or partial tear is wrong.
- Always add clear notes, imaging, and reports to support the claim.
Modifiers Use with CPT 27650
Modifiers give payers extra detail about the procedure. They tell the full story and prevent confusion. Here are some common modifiers used with CPT 27650.
Common Modifiers for CPT 27650:
Modifier 59
Modifier 59 is used if Achilles repair is done with another distinct procedure on the same leg. For example, tendon repairs plus removal of a foreign body.
Modifier 50
Modifier 50 is used for bilateral procedures. Rare for Achilles since both tendons rarely rupture at once, but still possible.
Modifier RT/LT
Modifier RT/LT is used to specify right or left tendon. These are critical because insurers require laterality.
Modifier 22
Modifier 22 is used for “increased complexity.” Use if the repair was unusually difficult, such as in obese patients, severe trauma, or complications. Documentation must support why extra effort was needed.
Other Related CPT Codes to Achilles Tendon Repair Procedure
Understanding related codes helps coders choose the right option. Here are some related CPT codes to CPT 27650.
- CPT 27652 is used for Secondary repair/reconstruction of Achilles tendon (revision or delayed repair).
- CPT 27654 is used for Tenolysis of Achilles tendon (release of scar tissue).
- CPT 27665 is used for Lengthening or shortening of Achilles tendon.
Conclusion
CPT Code 27650 is a critical code in orthopedic medical billing. In simple terms, CPT 27650 is used for primary surgical repair of a fresh Achilles tendon rupture. It applies to sports injuries, trauma, or sudden ruptures where the tendon is repaired right away.
To code and bill it correctly, focus on:
- Accurate diagnosis.
- Detailed operative notes.
- Correct modifiers.
- Awareness of the 90-day global period.
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