Summary & Overview
CPT 27386: Secondary Repair of Quadriceps or Hamstring with Autograft
CPT code 27386 designates a surgical procedure for secondary repair of quadriceps or hamstring muscle tears using an autologous graft from tendon or fascia. This code applies when reconstruction occurs days after initial rupture or when a prior repair is unsatisfactory. Nationally, accurate use of 27386 affects surgical case mix reporting, reimbursement for complex soft-tissue reconstructions, and quality measurement for musculoskeletal surgical care.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication summarizes how 27386 is categorized for billing, common clinical settings where it is used (hospital outpatient departments, inpatient ORs, and ambulatory surgery centers), and implications for claims processing and utilization tracking.
Readers will find: concise clinical context for the procedure; benchmarks and payment considerations from major national payers; coding and documentation points relevant to secondary muscle reconstruction; and policy or coverage highlights that influence approval and reimbursement. Data not available in the input will be identified where relevant.
Billing Code Overview
CPT code 27386 describes secondary repair of a quadriceps or hamstring muscle tear using an autograft taken from a tendon or fascial source. Secondary reconstruction denotes repair performed at least a few days after the initial muscle rupture or when an initial repair is not satisfactory.
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Service type: Surgical secondary muscle reconstruction involving graft harvest and repair of quadriceps or hamstring muscle tears.
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Typical site of service: Hospital outpatient department or inpatient operating room, and ambulatory surgery center depending on clinical complexity and patient status.
Clinical & Coding Specifications
Clinical Context
A 42-year-old recreational athlete sustained a proximal quadriceps tendon avulsion during a fall while playing soccer. Initial conservative management and attempted primary repair at an outside facility were unsatisfactory, and persistent weakness, pain, and a palpable defect persisted several weeks after injury. The orthopedic surgeon evaluates the patient in clinic, reviews prior operative notes and imaging (MRI demonstrating retracted quadriceps musculotendinous junction), obtains preoperative clearance, and schedules a secondary reconstruction using autograft fascia lata or hamstring tendon to bridge the defect.
The clinical workflow includes: preoperative evaluation and informed consent; review of prior imaging and operative reports; anesthesia assessment (general or regional); operative harvesting of autograft (for example, ipsilateral fascia lata or semitendinosus tendon); reconstruction of the quadriceps or hamstring muscle-tendon unit with graft fixation; intraoperative assessment of tension and range of motion; layered closure and postoperative immobilization or bracing. Postoperative care involves routine surgical follow-up, wound checks, pain control, and staged physical therapy focusing on protected range of motion followed by progressive strengthening.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the secondary reconstruction requires substantially greater work than typical due to extensive scar tissue, multiple graft harvest sites, or complex revisions. |
23 | Unusual anesthesia | Use if general anesthesia is contraindicated and an unusual anesthesia technique is required or patient intolerance necessitates additional anesthesia resources. |
26 | Professional component | Use when reporting only the professional component of a service that has distinct technical and professional parts (rare for this surgical code). |
50 | Bilateral procedure | Use if simultaneous bilateral secondary reconstructions are performed. |
51 | Multiple procedures | Use when additional distinct procedures are performed during the same operative session (in conjunction with appropriate modifier sequencing rules). |
52 | Reduced services | Use when the procedure is partially reduced or not completed as originally planned. |
53 | Discontinued procedure | Use when the procedure is terminated due to extenuating circumstances prior to completion. |
58 | Staged or related procedure during post-op period | Use when the secondary reconstruction is planned as a staged procedure during the global period of a prior related surgery. |
62 | Two surgeons | Use when two surgeons with different specialties operate together and each performs distinct portions of the reconstruction. |
63 | Procedure performed on infants less than 4 kg | Not commonly applicable but included when patient meets criteria. |
76 | Repeat procedure by same physician | Use when the same surgeon performs a repeat reconstruction during the postoperative period (note: 76 is not in the provided list; adhere to provided list—omit). |
78 | Unplanned return to OR for related procedure during global period | Use when the patient requires an unplanned return to the operating room for a complication related to the reconstruction. |
79 | Unrelated procedure or service by the same physician during global period | Use when an unrelated surgical procedure is performed during the global period of the reconstruction. |
RT | Right side | Use to designate the right-sided procedure when sides are reported. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207L00000X | Orthopaedic Surgery | Primary specialty performing secondary quadriceps/hamstring reconstructions. |
| 2080P0207X | Sports Medicine (Orthopaedic) | Specialists focusing on athletic injuries and complex muscle-tendon repairs. |
| 2085S0010X | Orthopaedic Trauma | Surgeons managing revisions and complex reconstructions after failed primary repairs. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
S76.021A | Strain of muscle, fascia and tendon of the right thigh, initial encounter | Acute quadriceps muscle/tendon injuries leading to secondary reconstruction when initial management fails. |
S76.022A | Strain of muscle, fascia and tendon of the left thigh, initial encounter | Left-sided equivalent; relevant when reconstruction is performed on the left limb. |
S76.11XA | Strain of hamstring muscle, fascia and tendon of right thigh, initial encounter | Hamstring tears that may require secondary reconstruction when there is significant retraction or failed primary repair. |
S76.12XA | Strain of hamstring muscle, fascia and tendon of left thigh, initial encounter | Left-sided hamstring injuries leading to secondary reconstruction. |
M66.861 | Spontaneous rupture of right quadriceps tendon | Indicates delayed or secondary repair context when rupture was not adequately repaired initially. |
M66.862 | Spontaneous rupture of left quadriceps tendon | As above for the left side. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
20680 | Removal of implant; deep (e.g., buried wires, pins, screws, metal band) when performed | May be performed prior to or during secondary reconstruction if prior fixation hardware is present and needs removal to access the repair site. |
20930 | Allograft, large, structural, for knee or other joint — includes processing, when used | Used when an allograft tendon or fascia is selected instead of autograft for reconstruction. |
23420 | Repair of quadriceps tendon, acute (primary repair) | Represents the primary repair code; useful for comparison and identifying that 27386 is a secondary reconstruction rather than an acute primary repair. |
27130 | Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip) | Data not typically related but included only if concomitant hip procedures are performed (if unrelated, use appropriate modifier). |
29881 | Arthroscopy, knee, surgical; with meniscal repair | Performed in the same operative session if intra-articular pathology is addressed concurrently with muscle reconstruction. |