Summary & Overview
CPT 27391: Open Tenotomy of Hamstring Muscles
CPT code 27391 identifies an open tenotomy procedure that surgically divides multiple hamstring tendons in one leg from knee to hip. Clinically, the code captures definitive surgical management for hamstring contractures or pathologic tightness that impair knee flexion or hip extension. Nationally, accurate coding for this procedure matters for procedure tracking, surgical quality measurement, and appropriate facility and surgeon billing.
Key payers commonly involved in coverage and claims adjudication include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, and an outline of common modifiers associated with surgical claims. The publication provides benchmarking benchmarks and payment policy context where available, highlights coding implications for facility and professional lines, and summarizes areas where documentation and coding specificity matter for payer review.
This summary is aimed at billing managers, clinical coders, and policy analysts seeking a national-level reference for CPT code 27391, including expected settings of care and the clinical rationale for use of the code. Data not available in the input is identified as such elsewhere in the document.
Billing Code Overview
CPT code 27391 describes an open tenotomy of the hamstring muscle group, involving surgical division of multiple hamstring tendons in one leg from the knee to the hip. The procedure targets the biceps femoris, semitendinosus, and semimembranosus muscles to release tight or contracted hamstrings.
Service type: Surgical — Open tendon release (tenotomy)
Typical site of service: Inpatient or outpatient hospital operating room or ambulatory surgical center, depending on clinical complexity and facility capabilities.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adolescent or adult presenting with persistent hamstring contracture or spasticity causing limited knee extension, gait abnormality, or pain after conservative therapy has failed. Common scenarios include post-stroke or cerebral palsy patients with chronic spasticity, athletes with scarred, retracted hamstring tendons after severe injury, or patients with fixed flexion deformity of the knee. The clinical workflow begins with evaluation by an orthopedic surgeon or physiatrist, review of prior nonoperative management (physical therapy, botulinum toxin, orthotics), and imaging as indicated (MRI or ultrasound to assess tendon pathology). Preoperative clearance and informed consent are obtained. In the operating room under general or regional anesthesia, the surgeon performs an open tenotomy of multiple hamstring tendons (biceps femoris, semitendinosus, semimembranosus) in one leg to lengthen or release the musculotendinous unit. Postoperative care includes pain control, wound care, physical therapy for range of motion and strengthening, and follow-up visits to monitor healing and functional improvement. Typical site of service is an inpatient or outpatient surgical suite at a hospital or ambulatory surgical center depending on patient comorbidities and anesthesia requirements. Expected documentation includes operative report detailing tendons divided, laterality, anesthesia, indications, pre- and postoperative diagnosis, and surgeon signature.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
RT | Right side | When procedure is performed on the right lower extremity |
LT | Left side | When procedure is performed on the left lower extremity |
50 | Bilateral procedure | When tenotomy is performed on both legs during the same operative session (if applicable to other codes) |
62 | Two surgeons | When two surgeons work together as primary surgeons performing distinct portions of the procedure |
80 | Assistant surgeon | When a surgical assistant performs part of the procedure |
62 | (duplicate entry avoided) | (see above) |
51 | Multiple procedures | When other unrelated procedures are performed at the same session in addition to the tenotomy |
53 | Discontinued procedure | When the procedure is started but discontinued due to extenuating circumstances |
22 | Increased procedural services | When work required is substantially greater than typical for this code (document rationale) |
24 | Unrelated E/M after procedure | When an unrelated evaluation and management service occurs during the postoperative period (not in input list; omitted) |
26 | Professional component | When professional component is reported separately (rare for surgical procedure; included when applicable for diagnostic adjuncts) |
52 | Reduced services | When a reduced service is performed compared with full procedure |
79 | Unrelated procedure or service by the same physician during the postoperative period | When an unrelated procedure is performed in the global period |
63 | Procedure on infants less than 4 kg | When patient meets weight criteria for neonatal modifier |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207L00000X | Orthopedic Surgery | Most common specialty performing open hamstring tenotomy |
| 208100000X | Physical Medicine & Rehabilitation | Performs evaluation, may coordinate spasticity management and select candidates for tenotomy |
| 2080P0025X | Neurology | Evaluates neurologic causes of spasticity; may be involved in multidisciplinary care |
| 2086S0105X | Pediatric Orthopedics | Manages pediatric patients with congenital or developmental disorders requiring hamstring lengthening |
| 366A00000X | Anesthesiology | Provides general or regional anesthesia for the procedure |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
M24.372 | Contracture, right knee | Fixed knee flexion contracture due to shortened hamstrings may require tenotomy |
M24.371 | Contracture, left knee | Same relevance for left-sided contracture |
G81.90 | Hemiplegia, unspecified affecting unspecified side | Spastic hemiplegia can cause hamstring spasticity leading to surgical release |
G80.9 | Cerebral palsy, unspecified | Cerebral palsy often causes dynamic and fixed hamstring contractures treated with lengthening/tenotomy |
S86.211A | Strain of muscle, fascia and tendon of right hamstring, initial encounter | Acute or chronic hamstring tendon injury leading to scar contracture necessitating surgical release |
M62.81 | Muscle weakness (generalized) | Documented localized muscle weakness or imbalance contributing to abnormal gait and need for surgical correction |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
20610 | Arthrocentesis, aspiration and/or injection; major joint or bursa (e.g., shoulder, hip, knee) | May be performed preoperatively for diagnostic or therapeutic injection of periarticular structures or for intraoperative joint management before or after tenotomy |
27650 | Repair, primary, open or percutaneous, ruptured Achilles tendon | Different lower-extremity tendon surgery; may be performed in patients with complex tendon pathology or as concurrent lower-extremity procedure in multisite surgery |
27447 | Arthroplasty, knee, condyle and plateau; medial and lateral compartments with or without patellar resurfacing | Major knee procedures that could be temporally related in cases with severe joint contracture requiring combined procedures; documentation must distinguish services |
20550 | Injection(s); single tendon sheath, or ligament, trigger point (1 or 2 muscle(s)) | May be used preoperatively for diagnostic or therapeutic injections of tendon sheath or trigger points related to hamstring pain |
97001 | Physical therapy evaluation | Postoperative rehabilitation service commonly used after hamstring tenotomy to restore function |