subcutaneous tissue, usually in the layer of fat over the fascia. Size and tumor origin play a role in code selection for excision of soft tissue tumors of the thigh. The entire resection is measured, not the diameter of the lesion itself, to determine the excision size. Excision of a tumor originating in the integument, eg, melanoma, is reported with Integumentary System excision codes.
27323 Biopsy, soft tissue of thigh or knee area; superficial 27324 deep (subfascial or intramuscular)
27325 Neurectomy, hamstring muscle 27326 Neurectomy, popliteal (gastrocnemius)
27327 Excision, tumor, soft tissue of thigh or knee area, subcutaneous; less than 3 cm
# 27337 3 cm or greater
27328 Excision, tumor, soft tissue of thigh or knee area, subfascial (eg, intramuscular); less than 5 cm 27329 Code is out of numerical sequence. See 27323-27365 # 27339 5 cm or greater
27330 Arthrotomy, knee; with synovial biopsy only
27331 including joint exploration, biopsy, or removal of loose or foreign bodies
27332 Arthrotomy, with excision of semilunar cartilage (meniscectomy) knee; medial OR lateral 27333 medial AND lateral
27334 Arthrotomy, with synovectomy, knee; anterior OR posterior
27335 anterior AND posterior including popliteal area 27337 Code is out of numerical sequence. See 27323-27365 27339 Code is out of numerical sequence. See 27323-27365
94 Moderate sedation ✚Add-on code Modifier 51 exempt #Resequenced code Netter’s Atlas of Surgical Anatomy for CPT Coding
Musculoskeletal System
27275—27335Semitendinosus m.
Semimembranosus m.
Gracilis m.
Tibial collateral ligament, parallel fibers, oblique fibers
Adductor magnus tendon
Anserine bursa under semi- tendinosus, gracilis, and sartorius tendons Bursa under semimembranosus tendon
Gastrocnemius m.
Popliteus m.
IIiotibial tract Biceps femoris m.,
long head, short head
Bursa under iliotibial tract
Plantaris m.
Peroneus longus m.
Tibialis anterior m.
Head of fibula Biceps femoris tendon and bursa
Common peroneal n.
Soleus m.
Gastrocnemius m.
Fibular collateral ligament and bursa
Sartorius m.
Vastus medialis m.
Patella Rectus femoris
tendon Lateral patellar retinaculum
Joint capsule Medial patellar retinaculum
Tuberosity of tibia Patellar ligament
Vastus lateralis m.
IIiotibial tract
Fibular collateral ligament and bursa Lateral patellar retinaculum
Lateral condyle of femur
Biceps femoris tendon and bursa
Insertion of iliotibial tract to oblique line of tibia Bursa under iliotibial tract
Head of fibula Peroneus longus m.
Common peroneal n.
Extensor digitorum longus m.
Tibialis anterior m.
Vastus lateralis m.
Articularis genus m.
Rectus femoris tendon Vastus medialis m.
Patella
Medial patellar retinaculum Medial condyle of femur
Semitendinosus, gracilis, and sartorius tendons Tibial collateral ligament
Anserine bursa Patellar ligament
Gastrocnemius m.
Tuberosity of tibia Medial condyle of tibia Femur
Medial view Lateral view
Anterior view FIGURE 2-41. Knee Joint
The knee is a hinge formed by the connection of three joints. The femur’s medial and lateral condyles articulate with the tibia’s medial and lateral condyles, and the third joint is between the patella and the femur. The patella protects the knee from its position anterior to the knee joint and slides up and down as the leg moves.
Moderate sedation ✚Add-on code Modifier 51 exempt #Resequenced code © 2015 American Medical Association 95
Netter’s Atlas of Surgical Anatomy for CPT Coding
Musculoskeletal System
FIGURE 2-42. Interior of the Knee
The knee has three compartments: medial, lateral, and patello-femoral. The medial compartment is the area of joint contact between the femur and tibia on the inside of the knee (eg, right side of left knee and left side of right knee). The lateral compartment is the outside (eg, left side of left knee and right side of right knee). The patello-femoral compartment is the area at which the patella articulates with the femur.
Patellar ligament
Medial patellar retinaculum blended into joint capsule
Suprapatellar synovial bursa Synovial membrane (cut edge) Infrapatellar synovial fold Posterior cruciate ligament Tibial collateral ligament (superficial and deep parts) Medial condyle of femur Oblique popliteal ligament Semimembranosus tendon lliotibial tract blended into lateral
patellar retinaculum and capsule Bursa Subpopliteal recess Popliteus tendon Fibular collateral ligament
Bursa Lateral condyle of femur Anterior cruciate ligament Arcuate popliteal ligament
Posterior meniscofemoral ligament Arcuate popliteal ligament Fibular collateral ligament
Bursa Popliteus tendon Subpopliteal recess Lateral meniscus Superior articular surface of tibia (lateral facet)
lliotibial tract blended into capsule
Infrapatellar fat pad
Semimembranosus tendon Oblique popliteal ligament
Posterior cruciate ligament Tibial collateral ligament (deep part bound to medial meniscus) Medial meniscus Synovial membrane Superior articular surface of tibia (medial facet) Joint capsule Anterior cruciate ligament Patellar ligament
Superior view Inferior view
Anterior aspect Posterior aspect
Suprapatellar (synovial) bursa
Cruciate ligaments (covered by synovial membrane)
Medial condyle of femur
Infrapatellar synovial fold
Medial meniscus
Alar folds (cut)
Infrapatellar fat pads (lined by synovial membrane)
Suprapatellar (synovial) bursa (roof reflected)
Vastus medialis muscle (reflected inferiorly) Joint opened,
knee slightly in flexion
Femur Articularis genus muscle Synovial membrane (cut edge)
Lateral condyle of femur Origin of popliteus tendon (covered by synovial membrane)
Subpopliteal recess Lateral meniscus Fibular collateral ligament
Head of fibula Patella (articular surface on posterior aspect)
Vastus lateralis muscle (reflected inferiorly)
96 Moderate sedation ✚Add-on code Modifier 51 exempt #Resequenced code
Musculoskeletal System
Netter’s Atlas of Surgical Anatomy for CPT Coding27340 Excision, prepatellar bursa
27345 Excision of synovial cyst of popliteal space (eg, Baker’s cyst)
27347 Excision of lesion of meniscus or capsule (eg, cyst, ganglion), knee
27350 Patellectomy or hemipatellectomy
27355 Excision or curettage of bone cyst or benign tumor of femur;
27356 with allograft
27357 with autograft (includes obtaining graft)
✚ 27358 with internal fixation (List in addition to code for primary procedure)
27360 Partial excision (craterization, saucerization, or diaphysectomy) bone, femur, proximal tibia and/or fibula (eg, osteomyelitis or bone abscess)
# 27329 Radical resection of tumor (eg, sarcoma), soft tissue of thigh or knee area; less than 5 cm
27364 5 cm or greater
27365 Radical resection of tumor, femur or knee
Introduction or Removal
Coding Atlas
Foreign body (FB) removal is reported using code 27372 when the FB is in muscle or deep fascia or in soft tissue adjacent to the knee capsule. Code 27372 does not include arthrotomy; see code 27331.
27370 Injection of contrast for knee arthrography
27372 Removal of foreign body, deep, thigh region or knee area
Repair, Revision, and/or Reconstruction
Coding Atlas
In arthroplasty, the native joint surface(s) are replaced with prosthetic parts. In revision arthroplasty, an existing prosthesis is replaced with a new component. In some cases, infection requires that an existing prosthesis be removed; however, a new prosthesis is not placed until weeks later when the infection has been eliminated.
27380 Suture of infrapatellar tendon; primary
27381 secondary reconstruction, including fascial or tendon graft
27385 Suture of quadriceps or hamstring muscle rupture;
primary
27386 secondary reconstruction, including fascial or tendon graft
27390 Tenotomy, open, hamstring, knee to hip; single tendon 27391 multiple tendons, 1 leg
27392 multiple tendons, bilateral
27393 Lengthening of hamstring tendon; single tendon 27394 multiple tendons, 1 leg
27395 multiple tendons, bilateral
27396 Transplant or transfer (with muscle redirection or rerouting), thigh (eg, extensor to flexor); single tendon 27397 multiple tendons
27400 Transfer, tendon or muscle, hamstrings to femur (eg, Egger’s type procedure)
27403 Arthrotomy with meniscus repair, knee
27405 Repair, primary, torn ligament and/or capsule, knee;
collateral
27407 cruciate
27409 collateral and cruciate ligaments 27412 Autologous chondrocyte implantation, knee 27415 Osteochondral allograft, knee, open
27416 Osteochondral autograft(s), knee, open (eg, mosaicplasty) (includes harvesting of autograft[s])
27418 Anterior tibial tubercleplasty (eg, Maquet type procedure)
27420 Reconstruction of dislocating patella; (eg, Hauser type procedure)
27422 with extensor realignment and/or muscle advancement or release (eg, Campbell, Goldwaite type procedure)
27424 with patellectomy 27425 Lateral retinacular release, open
27427 Ligamentous reconstruction (augmentation), knee; extra- articular
27428 intra-articular (open)
27429 intra-articular (open) and extra-articular 27430 Quadricepsplasty (eg, Bennett or Thompson type) 27435 Capsulotomy, posterior capsular release, knee 27437 Arthroplasty, patella; without prosthesis 27438 with prosthesis
27440 Arthroplasty, knee, tibial plateau;
27441 with debridement and partial synovectomy 27442 Arthroplasty, femoral condyles or tibial plateau(s), knee;
27443 with debridement and partial synovectomy
Netter’s Atlas of Surgical Anatomy for CPT Coding
Musculoskeletal System
27340—27443Moderate sedation ✚Add-on code Modifier 51 exempt #Resequenced code © 2015 American Medical Association 97
FIGURE 2-43. Ligaments of the Knee
Stability to the knee joint is provided by the medial collateral ligament (MCL), posterior cruciate ligament (PCL), and anterior cruciate ligament (ACL). The MCL and LCL limit sideways motion, and the PCL and ACL control the front and back motion of the knee. The MCL is also called the tibial collateral ligament.
Right knee in flexion: Anterior view
Anterior cruciate ligament Lateral condyle of femur (articular surface) Popliteus tendon Fibular collateral ligament Lateral meniscus
Transverse ligament of knee Head of fibula Gerdy’s tubercle
Posterior cruciate ligament
Medial condyle of femur (articular surface)
Medial meniscus
Tibial collateral ligament
Medial condyle of tibia
Tibial tuberosity
Posterior cruciate ligament Anterior cruciate ligament
Posterior meniscofemoral ligament
Lateral condyle of femur (articular surface) Popliteus tendon Fibular collateral ligament Lateral meniscus Head of fibula Medial condyle of femur (articular surface)
Adductor tubercle on medial epicondyle of femur
Medial meniscus
Tibial collateral ligament
Medial condyle of tibia
Right knee in extension:
Posterior view
98 Moderate sedation ✚Add-on code Modifier 51 exempt #Resequenced code
Musculoskeletal System
Netter’s Atlas of Surgical Anatomy for CPT Coding27445 Arthroplasty, knee, hinge prosthesis (eg, Walldius type) 27446 Arthroplasty, knee, condyle and plateau; medial OR
lateral compartment
27447 medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty) 27448 Osteotomy, femur, shaft or supracondylar; without
fixation 27450 with fixation
27454 Osteotomy, multiple, with realignment on intramedullary rod, femoral shaft (eg, Sofield type procedure)
27455 Osteotomy, proximal tibia, including fibular excision or osteotomy (includes correction of genu varus [bowleg] or genu valgus [knock-knee]); before epiphyseal closure 27457 after epiphyseal closure
27465 Osteoplasty, femur; shortening (excluding 64876) 27466 lengthening
27468 combined, lengthening and shortening with femoral segment transfer
27470 Repair, nonunion or malunion, femur, distal to head and neck; without graft (eg, compression technique) 27472 with iliac or other autogenous bone graft (includes
obtaining graft)
27475 Arrest, epiphyseal, any method (eg, epiphysiodesis);
distal femur
27477 tibia and fibula, proximal
27479 combined distal femur, proximal tibia and fibula 27485 Arrest, hemiepiphyseal, distal femur or proximal tibia or
fibula (eg, genu varus or valgus)
27486 Revision of total knee arthroplasty, with or without allograft; 1 component
27487 femoral and entire tibial component
27488 Removal of prosthesis, including total knee prosthesis, methylmethacrylate with or without insertion of spacer, knee
27495 Prophylactic treatment (nailing, pinning, plating, or wiring) with or without methylmethacrylate, femur 27496 Decompression fasciotomy, thigh and/or knee, 1
compartment (flexor or extensor or adductor);
27497 with debridement of nonviable muscle and/or nerve 27498 Decompression fasciotomy, thigh and/or knee, multiple
compartments;
27499 with debridement of nonviable muscle and/or nerve
Fracture and/or Dislocation
Coding Atlas