Sports injuries happen in the blink of an eye, but their impact on patients’ lives and your billing can last much longer. Achilles tendon ruptures are a common injury that can happen during sports or other kinetic activities. Their treatment is usually surgical, and they often have high reimbursement rates.
Therefore, healthcare providers cannot afford to have their claims denied. Otherwise, they can lose a significant amount of revenue. That is why we have created this detailed guide on CPT code 27650, which represents the primary treatment for Achilles tendon ruptures.
CPT Code 27650 – Description
CPT code 27650 is defined as:
“Repair, primary, open or percutaneous, ruptured Achilles tendon.”
The code represents a comprehensive surgical procedure on the Achilles tendon, which is the largest tendon in the human body. The surgery acts as a primary repair procedure when the tendon is ruptured.
Since it is only a primary surgery, it can be performed using either an open surgical approach or percutaneous (minimally invasive) techniques. Please note that 27650 does not involve any grafting. However, if during the surgery, the surgeon decides that grafting is necessary, then 27652 should be used.
The surgery is usually completed within 60 minutes. Both regional and general anesthesia can be used during surgery. So, you must also use the appropriate anesthesia billing code.
Scenarios Where CPT Code 27650 is Applicable
To better understand the effective use of CPT code 27650, let’s discuss a couple of real-world scenarios in which this code is applicable:
Sports Injury
Suppose a 35-year-old man is playing basketball. To score a goal, he makes a quick jump. However, he feels a sudden severe pain in the back of his ankle. He explains the feeling like a pop in this leg. Later, he visits an orthopedic practice to get treatment. The physician performs a Thompson test, which shows a positive Achilles rupture. The physician also orders an MRI to verify the diagnosis and check the extent of the tear.
The MRI shows a complete rupture. So, surgery is the only treatment option. The surgeon uses a percutaneous surgery method to fix the tendon. In this scenario, the surgery can be billed via CPT code 27650.
Workplace Injury
A construction worker suffers an Achilles tendon rupture after falling from a ladder. The injury occurs during a sudden dorsiflexion movement as he attempts to regain balance. Clinical examination and imaging studies confirm a complete rupture located in the mid-substance of the tendon.
Since this represents a fresh, traumatic rupture in a healthy tendon, the orthopedic surgeon opts for primary repair using a minimally invasive percutaneous technique. This scenario perfectly fits the criteria for CPT code 27650.
Applicable Modifiers for CPT Code 27650
Want to clarify how you performed the Achilles tendon repair? You can use the following modifiers in your claims to provide more information about the procedure:
| Modifier | Description | Clinical Application |
|---|---|---|
| 22 | Increased Procedural Services | When significantly more work is required due to unusual circumstances. |
| 50 | Bilateral Procedure | When performed on both sides simultaneously. Rare but still possible. |
| 59 | Distinct Procedural Service | When representing a distinct service from other procedures performed on the same day. |
| LT | Left Side | Laterality modifier for left Achilles tendon procedures. |
| RT | Right Side | Laterality modifier for right Achilles tendon procedures. |
CPT Code 27650 – Billing & Reimbursement Guidelines
To ensure proper reimbursement and improve claims acceptance rates, you must follow specific billing guidelines and avoid common errors. The following are some essential points to focus on:
Medicare Reimbursement Rates
The reimbursement amount for CPT code 27650 varies for each MAC locality. However, Medicare has set its national average reimbursement amount at $652.11 for facility settings.
You can check the reimbursement rate for your MAC locality via the PFS Lookup Tool.
Documentation Requirements
Providing detailed documentation with your claims is essential if you want to avoid denials. For 27650, you must include the following details:
- Operative notes that describe the surgical technique employed (open versus percutaneous).
- Any observations made by the surgeon during surgery.
- Repair method utilized.
- Any complications encountered during the procedure.
- Proper diagnosis codes, such as S86.011A or S86.012A.
Common Billing Errors
- Incorrect Code Selection: Ensure you are using 27650 for primary repairs only. Secondary repairs require CPT 27654, while repairs with grafts use CPT 27652.
- Missing Modifiers: Always use laterality modifiers (LT/RT). Without them, your claims will be rejected.
- Inadequate Documentation: Insufficient operative notes or missing preoperative imaging may result in medical necessity denials.
- Global Period: The global surgical period for CPT code 27650 is 90 days, meaning that all routine preoperative care, the surgical procedure itself, and postoperative follow-up visits within 90 days are bundled into a single payment.
Wrapping Up
Let’s do a quick recap of everything we have discussed so far.
CPT code 27650 reports a primary repair surgery of the Achilles tendon. It has a global period of 90 days, and you must append the appropriate modifiers and documentation with your claims for proper reimbursement.
If you are facing frequent denials, consider employing expert orthopedic billing services. Many companies, like MediBillMD, offer specialized services with guaranteed reduction in denials and a boost in revenue.
