Summary & Overview
CPT 27420: Patellar Tendon Transfer with Bone Block
CPT code 27420 represents an orthopedic surgical procedure that transfers the entire patellar tendon insertion as a bone block to treat a dislocating patella. The procedure is clinically significant nationwide because patellar instability causes pain, functional limitation, and recurrent healthcare utilization; surgical realignment procedures like this one are a common definitive treatment when conservative measures fail. Key national payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise clinical and billing overview, including the procedure’s clinical context, typical sites of service (hospital inpatient or outpatient surgical center), and common billing considerations. The publication summarizes benchmarking information, common modifier usage where applicable, and the clinical indications that generally support use of the code. It also outlines payer coverage patterns and policy considerations that affect prior authorization and payment, and points to related codes and documentation elements important for coding accuracy. Data not available in the input is noted explicitly where gaps exist.
Billing Code Overview
CPT code 27420 describes a surgical procedure in which the provider transfers the entire patellar tendon insertion as a bone block to treat a dislocating patella. This operation addresses recurrent or unstable patellar dislocation by realigning the patellar tendon attachment to improve patellar tracking and reduce episodes of lateral displacement.
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Service type: Orthopedic surgical procedure — patellar tendon transfer with bone block
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Typical site of service: Hospital inpatient or outpatient surgical center, depending on clinical complexity and perioperative needs
Clinical & Coding Specifications
Clinical Context
A 22-year-old recreational athlete presents with recurrent lateral patellar dislocations and chronic anterior knee pain despite conservative management (physical therapy, bracing, activity modification). Examination shows a positive apprehension sign and maltracking; imaging (radiographs, MRI) demonstrates patellar instability with lateralization of the patellar tendon insertion and a prominent tubercle-trochlear distance. The orthopedic surgeon schedules an open patellar tendon transfer with bone block (27420) to realign the extensor mechanism.
Preoperative workflow includes history and physical, informed consent discussing risks (infection, stiffness, failure of fixation), preoperative imaging review, and anesthesia evaluation. Intraoperative steps involve general or regional anesthesia, exposure of the patellar tendon insertion, osteotomy of the tibial tubercle with transfer of the bone block and fixation to a new medialized bed, assessment of patellar tracking through range of motion, and closure. Postoperative care includes analgesia, immobilization or hinged knee brace with protected weightbearing, DVT prophylaxis as indicated, and outpatient physical therapy focusing on quadriceps control and gradual range-of-motion and strengthening progression. Typical site of service is an outpatient ambulatory surgery center or inpatient hospital operating room depending on comorbidities and payer requirements.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |