Summary & Overview
CPT 25274: Delayed Extensor Tendon/Muscle Repair with Autologous Graft
CPT code 25274 denotes a delayed surgical repair of an extensor tendon or muscle in the forearm or wrist that includes use of an autologous tissue graft. This code captures a specialized reconstructive procedure performed after the initial traumatic injury, often when primary repair is not feasible due to tissue loss, scarring, or delayed presentation. Nationally, accurate coding for this service affects surgical quality measurement, operative reimbursement, and appropriate placement of care across inpatient and outpatient surgical settings.
Key payers discussed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise view of coverage considerations, common modifier usage, and coding contexts relevant to surgical and orthopedic practices and billing teams.
Readers will learn how CPT code 25274 is defined clinically, typical sites of service where the procedure is performed, and the types of documentation and clinical scenarios that align with this code. The piece also summarizes expected benchmarking areas and policy-relevant points that influence payer coverage determinations and claims adjudication. Data not available in the input is noted where applicable; the focus remains on clear clinical and coding interpretation to support operational and compliance needs for national audiences.
Billing Code Overview
CPT code 25274 describes a delayed repair of an extensor tendon or muscle in the forearm or wrist with autologous tissue graft. The procedure involves repairing an extensor tendon or muscle after a period of time has passed since the original traumatic injury and includes application of a tissue graft harvested from another site in the patient’s body.
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Service type: Surgical repair of extensor tendon/muscle with tissue graft (delayed)
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Typical site of service: Hospital operating room or ambulatory surgery center, depending on clinical complexity and facility capabilities
Clinical & Coding Specifications
Clinical Context
A 42-year-old right-hand–dominant construction worker presents 8 weeks after sustaining a deep laceration to the dorsal wrist from a job-related accident. He initially received wound care and temporary closure at an urgent care facility. Persistent inability to actively extend the wrist and digits and exam findings consistent with extensor tendon discontinuity prompt referral to hand surgery. Imaging and operative planning confirm a delayed repair of an extensor tendon in the distal forearm/wrist with the need for an autologous tissue graft to bridge tendon loss. In the operating room under regional block or general anesthesia, the hand surgeon explores the extensor compartment, debrides tendon ends, harvests a tendon graft (for example from the palmaris longus or a local tendon), and performs a tendon graft reconstruction with appropriate tensioning and repair technique. Postoperative care includes immobilization, early supervised hand therapy, and follow-up visits to monitor tendon healing and function.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, or technical difficulty substantially exceeds typical for 25274. |
23 |