Summary & Overview
CPT 20924: Tendon and Ligament Repair with Autograft Harvest
CPT code 20924 denotes surgical repair of tendons and ligaments using graft material harvested from the patient’s own tendons (autograft), such as the palmaris, toe extensor, or plantaris tendons. This procedure is a key option in reconstructive orthopedic and hand surgery when local repair is insufficient. Nationally, proper coding of this service affects procedure reporting, claims adjudication, and aggregate utilization statistics for musculoskeletal reconstructive care.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, common places of service (hospital operating room and ambulatory surgical centers), and the typical surgical intent (reconstruction using autograft tendon tissue). The publication provides benchmarks for coding practice, notes on common modifiers used in billing, and describes implications for coverage and claims processing. It also outlines how this code interacts with related procedure coding in orthopedic and hand surgery settings.
The content is designed to help billing managers, compliance officers, and clinical coders understand the clinical basis of CPT code 20924, how it is documented in operative reports, and what to expect in payer adjudication patterns. Data not available in the input includes specific payer fee schedules, frequency statistics, and linked ICD-10 diagnosis codes.
Billing Code Overview
CPT code 20924 describes a surgical procedure in which a provider repairs damaged tendons and ligaments using autologous graft material harvested from the patient's own tendons. Common donor tendons include the palmaris tendon in the hand, the toe extensor tendon in the foot, or the plantaris tendon in the ankle.
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Service type: Surgical tendon/ligament reconstruction with autograft harvest
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Typical site of service: Hospital operating room or ambulatory surgical center, depending on clinical complexity and patient factors
Clinical & Coding Specifications
Clinical Context
A 32-year-old right-handed construction worker presents after a penetrating injury to the volar wrist with an associated laceration and loss of flexor tendon continuity. Examination and imaging confirm a ruptured flexor tendon with insufficient local tissue for primary repair. The hand surgeon schedules an operative procedure to reconstruct the tendon using an autogenous tendon graft harvested from the palmaris longus in the forearm. The workflow includes preoperative evaluation (history, focused physical exam, informed consent), operative harvest of the donor tendon, preparation of the graft, reconstruction of the damaged tendon with appropriate fixation and tensioning, irrigation and layered closure of both donor and recipient sites, postoperative immobilization in a protective splint, and arranged hand therapy for progressive range of motion and strengthening.
Typical site of service: Ambulatory surgery center or hospital outpatient operating room.
Service type: Surgical tendon graft harvest and tendon reconstruction using autogenous graft material.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
RT | Right side | Use when the procedure is performed on the right extremity. |
LT | Left side | Use when the procedure is performed on the left extremity. |
50 | Bilateral procedure | Use when identical procedures are performed bilaterally during the same operative session. |
59 | Distinct procedural service | Use when another procedure performed at the same session is separate and not part of the tendon graft service. |
76 | Repeat procedure by same physician | Use if the same procedure is repeated later on the same day by the same provider (note: 76 not in provided list; use clinically relevant alternatives from list). |
78 | Unplanned return to the operating room for a related procedure during the postoperative period | Use when the patient returns to OR for a complication related to the initial tendon graft. |
79 | Unrelated procedure or service by the same physician during the postoperative period | Use when an unrelated surgical procedure is performed during the global period. |
22 | Increased procedural services | Use when work required to perform the surgery is substantially greater than usual. |
52 | Reduced services | Use when the service is partially reduced or not completed. |
53 | Discontinued procedure | Use when the procedure is started but then terminated due to extenuating circumstances. |
26 | Professional component | Use if reporting only the professional component of a service that has a technical component (rare for this CPT). |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for surgical procedures in an ambulatory surgical center | Use when applicable per payer rules to indicate a non-physician assistant performed the service under physician direction. |
QK | Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals | Use when anesthesia medical direction requirements are reported (if applicable). |
QX | CRNA service: CRNA with medical direction by physician | Use when a CRNA provided anesthesia services under physician direction. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207L00000X | Orthopedic Surgery | Orthopedic surgeons commonly perform tendon grafting for extremity tendon reconstruction. |
207P00000X | Plastic and Reconstructive Surgery | Plastic surgeons perform tendon graft harvest and reconstruction in complex soft tissue and hand cases. |
2080P0206X | Hand Surgery (Orthopedic) | Hand surgery specialists focus on tendon repairs and grafting techniques. |
163W00000X | General Surgery | General surgeons may perform tendon grafting in select trauma or peripheral tendon injuries. |
363L00000X | Physical Medicine & Rehabilitation | PM&R physicians coordinate postoperative rehabilitation, though they do not perform the surgical procedure. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
S66.241A | Laceration of flexor tendon of right wrist, initial encounter | Common indication when a flexor tendon is transected and requires reconstruction with grafting. |
S66.242A | Laceration of flexor tendon of left wrist, initial encounter | As above for the left side. |
S56.311A | Strain of flexor tendon of right forearm, initial encounter | Tendon grafting may be indicated for severe tendon injuries not amenable to primary repair. |
M66.811 | Spontaneous rupture of other flexor tendons, right hand | Degenerative or spontaneous ruptures sometimes require graft reconstruction. |
M24.461 | Recurrent dislocation, right wrist | Chronic instability or recurrent disruption may lead to reconstructive tendon graft procedures. |
S86.311A | Laceration of tendon, right lower leg, initial encounter | Donor tendon harvest (eg, toe extensor or plantaris) may be selected based on location and availability. |
T79.A11 | Traumatic compartment syndrome of right upper limb | Severe traumatic injuries with compartment syndrome can result in tendon damage requiring grafting. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
26160 | Tendon sheath incision (eg, tenolysis), flexor or extensor; single tendon | Performed when tenolysis is needed concurrently to free adhesions before grafting. |
24341 | Tendon graft, forearm; palmaris longus tendon (includes harvest and preparation) | Directly related as a common donor graft source; may be coded when separate reporting of graft harvest is required. |
26420 | Tendon repair, hand; primary, flexor or extensor, each tendon | Performed when direct repair (instead of graft) is feasible or as part of a combined repair strategy. |
29848 | Arthroscopy, wrist, surgical; debridement, synovectomy, or exploration | May be performed before or with tendon reconstruction for intra-articular pathology contributing to dysfunction. |
29515 | Application of short arm splint (forearm, volar or dorsal), static | Used postoperatively for immobilization of the donor and recipient sites. |
97035 | Ultrasound therapy, each 15 minutes (Therapeutic) | Represents possible postoperative adjunctive therapy during rehabilitation (note: modality codes vary by payer). |