CPT 27409: Primary Repair of Knee Collateral and Cruciate Ligaments - OpenPayer

Summary & Overview

CPT 27409: Primary Repair of Knee Collateral and Cruciate Ligaments

CPT code 27409 represents primary surgical repair of torn collateral and cruciate ligaments and/or the knee capsule performed immediately after injury. This code captures acute operative management of significant knee ligament disruptions, a procedure that has implications for trauma care pathways, surgical resource use, and rehabilitation planning nationwide. The code is relevant to hospital systems, orthopedic surgeons, surgical payers, and policymakers focused on acute musculoskeletal injury management.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, billing considerations, and payer coverage patterns where available. The publication highlights benchmark metrics and payer policy updates that affect authorization, billing, and site-of-service determination.

The article provides clinical background to help nonoperative stakeholders understand when primary repair is coded, summarizes common billing modifiers and documentation touchpoints (listed separately), and outlines implications for utilization management and post-acute care coordination. Data not available in the input for specific associated taxonomies, ICD-10 diagnoses, and related codes is noted as such in the detailed sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 27409knee ligament repairorthopedic surgeryacute surgical repairhospital outpatientsurgical billingtrauma surgerymusculoskeletal

Billing Code Overview

CPT code 27409 describes primary repair of torn collateral and cruciate ligaments and/or capsule of the knee performed immediately after injury. The procedure involves direct surgical repair of torn ligamentous structures around the knee, including collateral ligaments (medial or lateral) and cruciate ligaments (anterior or posterior), and may include repair of the joint capsule when injured.

Service type: Acute surgical ligament repair

Typical site of service: Hospital inpatient or outpatient surgical center, depending on clinical status and surgeon decision.

Clinical & Coding Specifications

Clinical Context

A 28-year-old male presents to the emergency department after a skiing accident with acute knee pain, swelling, and instability. Physical exam demonstrates a positive valgus stress test and anterior drawer laxity; MRI confirms avulsion/tear of the medial collateral ligament (MCL) and partial tear of the anterior cruciate ligament (ACL) with associated capsular disruption. The patient is evaluated by an orthopedic surgeon who documents an acute injury amenable to primary repair. The clinical workflow includes initial ED stabilization and imaging, preoperative clearance, informed consent for primary repair of collateral and/or cruciate ligament(s) and capsule, operative repair under general or regional anesthesia in an operating room, intraoperative documentation of torn structures and repair technique, and postoperative instructions including immobilization, pain control, and referral to physical therapy. Typical intraoperative documentation includes laterality, specific ligaments repaired (e.g., MCL, LCL, ACL, PCL), repair versus reconstruction distinction, estimated blood loss, implants if used, and any intraoperative complications.

Coding Specifications

Modifier	Description	When to Use
`00`	Service not applicable for modifier — placeholder in input	Data not available in the input.

| 11 | Office/outpatient E/M default — professional component not implied by this modifier set | Rarely appended to surgical procedure codes; use per payer guidance when required to indicate standard service. |

CPT 27495: Femoral Defect Fixation with Internal Implants

cpt-27440-tibial-knee-joint-reconstruction

CPT 27440: Tibial Reconstruction of the Knee Joint, Reconstructive Surgery

cpt-27450-femoral-osteotomy-with-fixation

CPT 27450: Femoral Osteotomy with Fixation

cpt-27428-knee-intra-articular-ligament-reconstruction

CPT 27428: Knee Intra-articular Ligament Reconstruction

cpt-27427-knee-extra-articular-ligament-reconstruction

CPT 27427: Reconstruction of Extra‑Articular Knee Ligaments

cpt-27393-hamstring-tendon-lengthening

CPT 27393: Hamstring Tendon Lengthening, Single Tendon

cpt-27470-femur-nonunion-malunion-repair-no-graft

CPT 27470: Repair of Femur Nonunion or Malunion Without Graft

cpt-27457-proximal-tibia-fibula-osteotomy-knee-realignment

CPT 27457: Proximal Tibia and Fibula Osteotomy for Knee Realignment

cpt-27475-distal-femur-epiphysiodesis-growth-plate-procedure

CPT 27475: Distal Femur Epiphysiodesis for Limb-Length Modulation

cpt-27429-knee-ligament-reconstruction-intra-extra-articular

CPT 27429: Reconstruction of Intra- and Extra-Articular Knee Ligaments

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Taxonomy Code	Specialty	Notes
207X00000X	Orthopaedic Surgery	Primary specialty performing ligament repairs of the knee.
2086S0122X	Orthopedic Sports Medicine	Subspecialists commonly perform complex knee primary repairs and manage perioperative care.
2080S0010X	Surgery — General (Orthopedic-trained surgeons sometimes use this taxonomy for billing)	Applicable when surgeon bills under a general surgery taxonomy with documented competence in knee procedures.
213E00000X	Emergency Medicine	Involved in initial evaluation, stabilization, and referral for operative management.
261Q00000X	Physical Therapist (PT)	Provides postoperative rehabilitation though not the surgical coder, included for care continuum context.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S83.41XA`	Sprain of medial collateral ligament of right knee, initial encounter	MCL tear is a common indication for primary repair when acute and repairable.
`S83.42XA`	Sprain of lateral collateral ligament of right knee, initial encounter	LCL injury may require primary repair depending on severity and concomitant injuries.
`S83.51XA`	Sprain of anterior cruciate ligament of right knee, initial encounter	ACL tears that are acute and amenable to primary repair (rare) or influence combined repair decisions.
`S83.52XA`	Sprain of posterior cruciate ligament of right knee, initial encounter	PCL tear may be repaired primarily in select acute settings.
`M23.61`	Other spontaneous disruption of medial meniscus, current	Meniscal injuries often accompany ligament tears and may be addressed during the same operative session.
`M24.2`	Disorder of ligament, right knee	Broad code representing chronic or unspecified ligament disorders that may necessitate surgical repair.
`S83.501A`	Sprain of unspecified ligament of right knee, initial encounter	Used when the specific ligament is not yet fully specified in early documentation; should be updated with operative findings.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`27370`	Arthrotomy, knee, with exploration, drainage, or synovectomy; may be performed for debridement	May be performed prior to or with repair when joint exploration or debridement is required.
`29888`	Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction	Common alternative or adjunct when ACL reconstruction rather than primary open repair is performed; may occur in staged or combined procedures.
`27427`	Ligamentous reconstruction (augmentation), knee; collateral ligament, extra-articular	Used when reconstruction/augmentation with graft is performed instead of primary repair for collateral ligament injuries.
`20680`	Removal of implant; implant parts, deep (e.g., screws, plates)	May be used in subsequent procedures if hardware removal is required after primary repair.
`99024`	Postoperative follow-up visit, routine (global period)	Used for postoperative visits within the global period for routine evaluation after the repair.

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