Summary & Overview
CPT 27698: Secondary Collateral Ligament Repair with Tendon Transfer
CPT code 27698 describes a secondary surgical repair of a disrupted collateral ligament using mobilized tendons to replace the ligament when the injury is chronic or not recent. This procedure is clinically important for restoring joint stability, improving function, and relieving pain after failed or delayed primary repair. Nationally, the code is relevant for orthopedic surgeons and surgical facilities managing complex ligament reconstructions that may require specialized operative time and postoperative rehabilitation.
Key payers commonly encountered for billing this procedure include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical intent and typical service context, plus what to expect in payer coverage discussions and benchmarking: reimbursement relevance for hospital and ambulatory surgical settings, common billing modifiers used in practice (provided in input), and clinical considerations tied to secondary reconstruction scenarios. The publication provides benchmarking context and policy notes where available and flags any missing input fields.
This summary equips billing managers, coding professionals, and clinical leaders with a clear understanding of CPT code 27698, its clinical purpose, and the payer landscape to support accurate coding and administrative planning for secondary collateral ligament reconstruction.
Billing Code Overview
CPT code 27698 describes a secondary repair of a disrupted collateral ligament in which the surgeon mobilizes other tendons to replace the damaged collateral ligament. This procedure is performed when the original injury is not recent and aims to restore joint function and relieve pain.
Service Type: Surgical reconstructive procedure — secondary collateral ligament reconstruction using tendon transfer or grafting techniques.
Typical Site of Service: Hospital operating room or ambulatory surgical center (facility-based surgical setting) with postoperative recovery; performed by an orthopedic surgeon or hand/foot specialist depending on the involved joint.
Clinical & Coding Specifications
Clinical Context
A 46-year-old manual laborer presents with chronic instability and pain of the lateral ankle following a remote severe inversion injury 18 months earlier. Conservative measures including bracing, physical therapy, and corticosteroid injections failed to restore stability and function. Imaging and clinical exam confirm a disrupted lateral collateral ligament complex with significant scarring and attenuation of native ligament tissue. The orthopedic foot and ankle surgeon plans a secondary collateral ligament reconstruction using tendon mobilization (tendon transfer) to recreate the collateral ligament and restore ankle stability and function. The patient is admitted for outpatient same-day surgery or overnight observation depending on comorbidities. The procedure includes anesthesia, surgical exposure, mobilization and transfer of a local tendon (for example peroneus brevis or posterior tibial tendon), fixation to bone with anchors or transosseous sutures, and layered soft-tissue closure. Postoperative workflow includes recovery room monitoring, postoperative immobilization in a splint or cast, standardized wound care instructions, pain management, and a structured rehabilitation protocol with protected weight bearing and progressive physical therapy starting after initial healing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased Procedural Services | Use when work, time, and complexity substantially exceed the usual for 27698. Documentation must justify the increased service. |