Bicep tendon repair cpt code

The long head of the biceps brachii tendon (LHBT) is a common source of pain in the shoulder. Biceps tendon pathology is often associated with rotator cuff (RC) pathology. The spectrum of LHBT injuries includes primary and secondary tendinitis, chronic tendinopathy, superior labrum anterior and posterior (SLAP) lesions, instability, …

Arthroscopic rotator cuff repair with arthroscopic proximal biceps tendon transfer I'd appreciate suggestions coding the above procedure. The other surgical coders and myself thought applying a 22 modifier would be sufficient, but the surgeon seems to think we should be able to bil... Arthroscopic Biceps Tenodesis. 29828 Arthroscopy, shoulder, surgical; bi ceps t enod esi s. A procedure that cuts the biceps tendon (long head) from where it attaches to the the upper rim of the glenoid (labrum), and reinserts it in another area. • CPT code 24342 is defined as Reinsertion of ruptured biceps or triceps tendon, distal, with or without tendon graft. • CPT code 76000 is defined as Fluoroscopy (separate procedure), up to 1 hour physician or other qualified health care professional time. • HCPCS code L8699 is defined as Prosthetic implant, not otherwise specified.Subscribe to get full access to this operation and the extensive Shoulder & Elbow Surgery Atlas. FREE TRIAL. Author: Institution: Learn the Repair of distal biceps rupture using Arthrex Biceps Button surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified….The long head of the biceps tendon (LHBT) is a frequent source of disorders and pathology in the shoulder. Significant evidence is available on the management of disorders of the LHBT in the literature, and the LHBT is frequently addressed intraoperatively when involved in shoulder pathology. An all-arthroscopic, intra-articular biceps tenodesis with suture anchor fixation has several ...

Patients eligible to receive CPT code 29828 services are those who have been diagnosed with instability of the biceps tendon due to biceps tendonitis, inflammation of the tendon, which often accompanies other shoulder problems such as chronic instability, arthritis, and impingement syndrome.Factory-issue car stereos sometimes come with an anti-theft device that renders the radio unusable unless you enter a code to unlock it. The code can be activated by disconnection ...Extensor tendon repair, dorsum of finger, single, primary or secondary, with free graft, (includes obtaining graft) each tendon (26420) Extensor tendon repair, central slip …CPT codes 29824 (Arthroscopic claviculectomy including distal articular surface), 29827 (Arthroscopic rotator cuff repair), and 29828 (Biceps tenodesis) may be reported separately with CPT code 29823 if the extensive debridement is performed in a different area of the same shoulder.Severe biceps tendonitis requires surgery – and Alison Cabrera, M.D., is one of few surgeons in the area offering a less invasive arthroscopic technique to repair the tendon and relieve shoulder pain. ... If physical therapy, rest, and medication don’t control the pain, you might need biceps tenodesis surgery to repair or re-anchor the ...Oct 18, 2011. #1. I am having some trouble finding a HCPCS code for a Toggleloc Elbow Implant System that is used in a Bicep Tendon Repair. This is an implant that is a piece of suture with titanium buttons on the end to repair the tendon. The CPT code used is 24341.

I use 24340 for longitudinal tears that would just be sutured, or partial tears that are repaired with anchors to the bone/or maybe repaired right back to the stump of tendon. I look at this code as a repair. I use 24342 for complete ruptures off the bone, where holes are drilled and tendon is reinserted through those drill holes.ChiroCode.com for Chiropractors CMS 1500 Claim Form Code-A-Note - Computer Assisted Coding Codapedia.com - Coding Forum Q&A CPT Codes DRGs & APCs DRG Grouper E/M Guidelines HCPCS Codes HCC Coding, Risk Adjustment ICD-10-CM Diagnosis Codes ICD-10-PCS Procedure Codes Medicare Guidelines NCCI …SLAP Repair Instability - Soft Tissue Bankart Repair - Arthroscopic - Dr. Stephen SnyderACHI Code: 48951-00 [1400] Arthroscopic decompression of subacromial space Rotator cuff repair Rotator cuff repair is a type of surgery to repair a torn tendon in the shoulder. This surgery is described as a mini-open repair because it is performed via a larger incision to allow the surgeon to visualise the rotator cuff rather than via the scope.I would recommend to query the provider as it does look like something is missing from the sentence describing the bicep tendon. If a rupture was identified I would think it would be okay to code for the tenodesis. If they are just identifying the bicep tendon I would think the tenodesis would not be billed separately and included within the ...Feb 8, 2016 · Feb 8, 2016. #1. I am having a problem coming up with the right code for a biceps tenotomy. PROCEDURE PERFORMED: 1. Diagnostic and surgical arthroscopy left shoulder with arthroscopic rotator cuff repair. 2. Left shoulder arthroscopic biceps tenotomy. I have seen some say to code as unlisted 29999. also seen saying using 29822 or 29823, that it ...

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Arthroscopic Rotator Cuff Repair and Bicep Tenodesis: Right Shoulder. John B. Hubbard, MD, an orthopaedic surgeon at Wake Forest Baptist Medical Center, performs an arthroscopic rotator cuff repair and bicep tenodesis on a right shoulder. View Doctor Profile. Published By. CPT. ®. 29828, Under Endoscopy/Arthroscopy Procedures on the Musculoskeletal System. The Current Procedural Terminology (CPT ®) code 29828 as maintained by American Medical Association, is a medical procedural code under the range - Endoscopy/Arthroscopy Procedures on the Musculoskeletal System. Complete rupture of the distal biceps tendon is routinely treated with direct repair; however, chronic, mid-substance, or musculotendinous tears are challenging clinical scenarios for surgeons. Although attempts at direct repair should be considered, in cases of severe retraction or tendon deficiency, a reconstruction may be warranted. Herein the authors describe a technique for distal biceps ...Extensor tendon repair, dorsum of finger, single, primary or secondary, with free graft, (includes obtaining graft) each tendon (26420) Extensor tendon repair, central slip … 24341 Repair, tendon or muscle, upper arm or elbow, each tendon or muscle, primary or secondary (excludes rotator cuff) 24342 Reinsertion of ruptured biceps or triceps tendon, distal, with or without tendon graft

Oct 19, 2022 · Because this Current Procedural Terminology code does not distinguish between distal biceps tendon and distal triceps tendon repairs, distal triceps tendon injuries were excluded based on International Classification of Diseases (ICD)-10 code S46.3∗∗ . Cases that reported an ICD-9 code during this period were excluded. Furthermore, obesity has been shown to decrease immune response to acute tendon injury. 15 Of patients with a distal biceps tendon rupture, 36–66% have reported to be obese. 11,12 The exact incidence of smoking in patients with distal biceps tendon ruptures is unknown, but it is widely accepted that smoking is a predisposing …Mar 1, 2024 · Coding Examples. Case example 1: Tenotomy of elbow performed using ultrasound-guided cutting device. Below we describe a typical patient with diseased tissue of the elbow to assess if CPT® codes 24357 and 76881 would be the appropriate coding option for billing this procedure. Typical patient: A 45-year-old male presents with chronic left ... Distal Biceps Repair Implant System. 04I Distal Biceps Repair Using the BicepsButton Implant and Tension-Slide Technique. With the elbow in full extension and full supination, expose the radial tuberosity and debride it of any remaining soft tissue. Drill a 3.2 mm bicortical tunnel through the radial tuberosity, aiming 30˚ ulnar to maximize ...Tendon Transfers / Tenodesis CPT Codes. MCP Sagittal Band Reconstruction. Muscle or tendon transfer, any type, upper arm or elbow, single (24301) Tenoplasty, with muscle transfer, with or without free graft, elbow to shoulder, single (Seddon- Brookes type procedure) (24320) Flexor-plasty, elbow, eg, Steindler type advancement) (24330) Flexor ...FIGURE 1. Cutaneous innervation of the upper extremity. Actual patients demonstrate large variation in the depicted pattern of innervation and significant crossover between nerves. FIGURE 2. Idealized distribution of the cutaneous innervation of the upper arm and forearm. Local Anesthetic and Adjuvant Selection.Video 1. This is a repair of a chronic distal biceps injury in a 53-year-old man with tendon retraction of 7 cm shown on magnetic resonance imaging. He is supine, with the arm over a hand table. Our technique for reconstruction of chronic distal biceps injuries uses an Achilles allograft through a modified Henry approach.Video 1. This is a repair of a chronic distal biceps injury in a 53-year-old man with tendon retraction of 7 cm shown on magnetic resonance imaging. He is supine, with the arm over a hand table. Our technique for reconstruction of chronic distal biceps injuries uses an Achilles allograft through a modified Henry approach.

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The biceps tenodesis procedure treats shoulder and biceps muscle pain and weakness that happens when you tear your long head biceps tendon. This tendon is located at the top of your bicep muscle. It’s connected to your labrum, which is cartilage that lines your shoulder socket. In the biceps tenodesis procedure, your surgeon releases your ...The biceps tenodesis procedure treats shoulder and biceps muscle pain and weakness that happens when you tear your long head biceps tendon. This tendon is located at the top of your bicep muscle. It’s connected to your labrum, which is cartilage that lines your shoulder socket. In the biceps tenodesis procedure, your surgeon releases your ...South Carolina Subscriber. Answer: Code 29828 ( Arthroscopy, shoulder,surgical; biceps tenodesis) covers arthroscopy of the shoulder in the biceps tenodesis region but does not include the arthroscopic bicep tenotomy. CPT does not yet include a code that describes arthroscopic biceps tenotomy. Most coders report the …Tendon / Muscle Repair CPT Codes - Proximal to hand. Repair, tendon or muscle, upper arm or elbow, each (24341) Reinsertion of ruptured biceps tendon, distal, with or without tendon graft (includes obtaining graft) (24342) Repair, tendon or muscle, flexor, forearm and/or wrist; primary, single, each tendon or muscle (25260) The FiberTak Biceps implant (K181769) is used for fixation of soft tissue to bone in the shoulder and elbow. Procedures include, but are not limited to: biceps tendon repair and reattachment (distal/proximal), acromioclavicular repair, and ulnar or radial collateral ligament reconstruction. Value Analysis Significance Apr 18, 2024 · The AHA Coding Clinic for HCPCS includes: The official publication for Level I HCPCS (CPT-4 codes) for hospital providers. Also specific Level II HCPCS codes for hospitals, physicians and other health professionals. Current newsletters added each quarter. Full Archives back to 2001. Fully searchable through Find-A-Code's Comprehensive Search. Answer: You can use 24342 (Reinsertion of ruptured biceps or triceps tendon, distal, with or without tendon graft ). This code specifies the reinsertion of ruptured biceps or triceps, distal end. Orthopedic surgeons always repair triceps distally. Another code possibility is 24341 (Repair, tendon or muscle, upper arm or elbow, each tendon or ...CPT codes 29824 (arthroscopic claviculectomy including distal articular surface), 29827 (arthroscopic rotator cuff repair), and 29828 (biceps tenodesis) may be reported separately with CPT code 29823 if the extensive debridement is performed in a different area of the same shoulder.

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This method of distal biceps reattachment has been utilized in our practice since December 2008 on 40 distal biceps tendon repairs. Biodex testing was used to quantify the peak supination torque, the supination work, and the power of supination at each degree of forearm rotation and included on patients with a minimum clinical follow …Amin NH, Volpi A, Lynch TS, Patel RM, Cerynik DL, Schickendantz MS, Jones MH. Complications of Distal Biceps Tendon Repair: A Meta-analysis of Single-Incision Versus Double-Incision Surgical Technique. Orthop J Sports Med. 2016 Oct 7;4(10):2325967116668137. doi: 10.1177/2325967116668137. PMID: 27766276; PMCID: …CPT® 23430, Under Repair, Revision, and/or Reconstruction Procedures on the Shoulder. The Current Procedural Terminology (CPT®) code 23430 as maintained by American Medical Association, is a medical procedural code under the range – Repair, Revision, and/or Reconstruction Procedures on the Shoulder. What is a biceps tendon rupture and how ...Mar 26, 2021 · This prospective study included 22 professional athletes undergoing surgical intervention for acute distal avulsion injuries of the biceps femoris tendon using a suture anchor repair technique. All operative procedures were performed by the senior author (F.S.H.) between 2005 and 2018. In the world of medical billing and coding, accurate CPT code descriptions are essential for ensuring proper reimbursement and maintaining compliance. CPT codes, or Current Procedu...Spontaneous rupture of other tendons, unspecified upper arm. M66.829 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2024 edition of ICD-10-CM M66.829 became effective on October 1, 2023. This is the American ICD-10-CM version of M66.829 - other international versions of ICD-10 M66 ...You may try to report this service as 26170 (Excision of tendon, palm, flexor or extensor, single, each tendon) with modifier 52 (Reduced services). For your diagnosis, you should report 727.63 (Rupture of tendon, nontraumatic; extensor tendons of hand and wrist), Grady says. Contemplate ModifiersThis prospective study included 22 professional athletes undergoing surgical intervention for acute distal avulsion injuries of the biceps femoris tendon using a suture anchor repair technique. All operative procedures were performed by the senior author (F.S.H.) between 2005 and 2018. ….

• CPT® codes 29874 (Surgical knee arthroscopy for removal of loose body or foreign body) and 29877 ((g py gSurgical knee arthroscopy for debridement/shaving of ... with t t ff iith rotator cuff repair – One or more of the SITS tendons are repaired with suture and/or bone anchors – Mini-open repair is reported with 23412, per CPTThe interference screw has also been show to induce direct tendon to bone healing which adds to the robustness of the construct. Kelly MP, Perkinson SG, Ablove RH, Tueting JL. Distal Biceps Tendon Ruptures: An Epidemiological Analysis Using a Large Population Database. Am J Sports Med. 2015 Aug;43(8):2012-7. doi: 10.1177/0363546515587738.Mar 26, 2021 · This prospective study included 22 professional athletes undergoing surgical intervention for acute distal avulsion injuries of the biceps femoris tendon using a suture anchor repair technique. All operative procedures were performed by the senior author (F.S.H.) between 2005 and 2018. You may try to report this service as 26170 (Excision of tendon, palm, flexor or extensor, single, each tendon) with modifier 52 (Reduced services). For your diagnosis, you should report 727.63 (Rupture of tendon, nontraumatic; extensor tendons of hand and wrist), Grady says. Contemplate ModifiersDistal Biceps Repair Implant System (includes BicepsButton™ implant, button inserter, FiberLoop® suture, 7 mm × 10 mm PEEK tenodesis screw, and BicepsButton drill pin) … Arthroscopic rotator cuff repair with arthroscopic proximal biceps tendon transfer I'd appreciate suggestions coding the above procedure. The other surgical coders and myself thought applying a 22 modifier would be sufficient, but the surgeon seems to think we should be able to bil... Scorpion needle isused to passsuture inside the body of the biceps tendon for the sake of anchoring before proximal tenotomy. (B) Through a posterior viewing portal, a Fork Tip Eyelet (Arthrex) is used to anchor the biceps tendon inside the tenodesis site. e1128 D. AOUAD AND G. EL RASSI29827-LT Arthroscopy, shoulder, surgical; with rotator cuff repair-Left side 29823-59-LT Arthroscopy, shoulder, surgical; ... Your suspicion that the bicep tenotomy is a bundled procedure is correct. Specifically, the tenotomy is bundled to the debridement (29823). ... From a CPT coding perspective, ... Bicep tendon repair cpt code, Arthroscopic Biceps Tenodesis. 29828 Arthroscopy, shoulder, surgical; bi ceps t enod esi s. A procedure that cuts the biceps tendon (long head) from where it attaches to the the upper rim of the glenoid (labrum), and reinserts it in another area., Check documentation to determine whether both code pair(s) can be billed or an additional site modifier added) 29820 (NCCI Edit.. Code 2 of a code pair with 29828 29823 that would be allowed if an approp. NCCI modifier were present.) DX: Acute massive RTC tear, bicep tenosynovitis, labral fraying with impingement, synovitis of the glenohumeral ..., Files related to Reinsertion of ruptured biceps tendon, distal, with or without tendon graft (includes obtaining graft) (24342) Find Window. X. Type in text to find: Hand Surgery CPT Codes, sorted by number. Tendon / Muscle Repair CPT Codes - Proximal to hand. American., Tenotomy: cut biceps tendon at anchor with curved sissors Tenodesis: pierce biceps tendon with spinal needle coming into the joint from the anterior lateral acromial border, though the rotator cuff interval, and through the biceps tendon, ACHI Code: 48951-00 [1400] Arthroscopic decompression of subacromial space Rotator cuff repair Rotator cuff repair is a type of surgery to repair a torn tendon in the shoulder. This surgery is described as a mini-open repair because it is performed via a larger incision to allow the surgeon to visualise the rotator cuff rather than via the scope. , Though rupture of the distal biceps tendon was earlier reported to be around 3% of all biceps tendon ruptures, it has been recently estimated to be closer to 10%. 24,25 Prior to 1995, there were 53 published articles concerning the distal biceps, in contrast to more than 70 new publications on this topic over the past 3 years, reflecting an ..., Feb 8, 2016 · Feb 8, 2016. #1. I am having a problem coming up with the right code for a biceps tenotomy. PROCEDURE PERFORMED: 1. Diagnostic and surgical arthroscopy left shoulder with arthroscopic rotator cuff repair. 2. Left shoulder arthroscopic biceps tenotomy. I have seen some say to code as unlisted 29999. also seen saying using 29822 or 29823, that it ... , Dec 14, 2018 · Check documentation to determine whether both code pair(s) can be billed or an additional site modifier added) 29820 (NCCI Edit.. Code 2 of a code pair with 29828 29823 that would be allowed if an approp. NCCI modifier were present.) DX: Acute massive RTC tear, bicep tenosynovitis, labral fraying with impingement, synovitis of the glenohumeral ... , Example: When an arthroscopic rotator cuff repair with debridement of the biceps tendon and debridement of the labrum is performed, you may report 29827 and 29823 because the bundling edit is removed from this code combination. When an arthroscopic repair of a superior labrum anterior and posterior (SLAP) lesion is performed with debridement of ..., CPT® 23430, Under Repair, Revision, and/or Reconstruction Procedures on the Shoulder. The Current Procedural Terminology (CPT®) code 23430 as maintained by American Medical Association, is a medical procedural code under the range – Repair, Revision, and/or Reconstruction Procedures on the Shoulder. What is a biceps tendon …, In this procedure, the provider surgically cleans the long tendon of the biceps from its damaged fragment and fixes the tendon to the upper end of the humerus to improve the stability of the joint. He performs this procedure to restore function to patients with severe damage of the biceps tendon due to conditions such as recurrent shoulder ... , Right biceps strain; Right biceps tendon tear; Right distal biceps tendon tear; ICD-10-CM S46.211A is grouped within Diagnostic Related Group(s) (MS-DRG v 41.0): 562 Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh with mcc; 563 Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without mcc, There is no unique CPT code for revision biceps tendon repair, and the minimal existing data on the incidence of contralateral biceps tendon ruptures after primary repair report rates at >4-year follow-up in small cohorts. 21–23 As this study evaluated a two-year follow-up, we assumed that the risk of capturing such instances was low, and ..., Distal Biceps Repair Using the BicepsButton Implant and Tension-Slide Technique I 05. Once the tendon is fully seated, use a free needle to pass one limb through the tendon and tie a knot, using a knot pusher if necessary. Pull on the free suture limbs to seat the button against the radius. Use fluoroscopy to confirm button deployment. , Left biceps strain; Left biceps tendon tear; Left distal biceps tendon tear; ICD-10-CM S46.212A is grouped within Diagnostic Related Group(s) (MS-DRG v 41.0): 562 Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh with mcc; 563 Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without mcc, I would recommend to query the provider as it does look like something is missing from the sentence describing the bicep tendon. If a rupture was identified I would think it would be okay to code for the tenodesis. If they are just identifying the bicep tendon I would think the tenodesis would not be billed separately and included within the ..., Spontaneous rupture of other tendons, right upper arm. M66.821 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2024 edition of ICD-10-CM M66.821 became effective on October 1, 2023., Feb 8, 2016. #1. I am having a problem coming up with the right code for a biceps tenotomy. PROCEDURE PERFORMED: 1. Diagnostic and surgical arthroscopy left shoulder with arthroscopic rotator cuff repair. 2. Left shoulder arthroscopic biceps tenotomy. I have seen some say to code as unlisted 29999. also seen saying using 29822 or 29823, that it ..., Long head biceps tendon pathology is a substantial contributor to anterior shoulder pain and often requires surgical intervention to offer a return to normal functionality. Surgical treatment options consist of both open and arthroscopic tenodesis or tenotomy of the long head biceps brachii. Several techniques exist for tenodesis and …, According to Nate Felt, MS, ATC, PTA, CPC, of Intermountain Medical Group in Utah, the two codes you would use for arthroscopic debridement are: 29822 (Arthroscopy, shoulder, surgical; debridement, limited, 1 or 2 discrete structures (eg, humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, …, We are having a battle with an insurance plan because they are only authorizing two codes from our four codes we originally requested - the codes they authorize are: 26356 and 26785. My question is, without an operative report, how would you code an ORIF with Tendon Repair on the ring finger..., Tendon / Muscle Repair CPT Codes - Proximal to hand. Repair, tendon or muscle, upper arm or elbow, each (24341) Reinsertion of ruptured biceps tendon, distal, with or without tendon graft (includes obtaining graft) (24342) Repair, tendon or muscle, flexor, forearm and/or wrist; primary, single, each tendon or muscle (25260), Peroneus Brevis Tendon Repair CPT Code. Peroneus brevis tendon repair is the surgical process of attaching the broken ends of tendon with muscle or bone. It is located on the lateral side of lower leg. The surgical repair is necessary to enable normal movement of leg. The CPT code for this procedure is 27658., Is Therapy Necessary After Distal Biceps Tendon Repair? Hand December 2008 vol 3 issue 4 pg:316-319. 7. Logan et al. Rehabilitation Following Distal Biceps Tendon …, it through the incision. Debride the end of the tendon to remove any degenerative or diseased tissue. The tendon should pass through a 7 mm sizing block to ensure that it will fit through an 8 mm bone tunnel. Whipstitch 2.5 cm of the distal end of the biceps tendon using a FiberLoop® suture, making sure to lock, 13131-13133: complex repair to forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet. 13151-13153: complex repair to eyelids, nose, ears, and/or lips. Each of the codes in the simple, intermediary and complex laceration repair code sets is classified by length of repair. For instance: 12001: 2.5 cm or less., There are thousands of existing codes that are updated each October. The current version is CPT 2018. But with thousands of codes out there at any given time, how can medical profe..., Distal biceps tendon repairs were isolated using the Current Procedural Terminology (CPT) code: 24342. Distal triceps tendon injuries were excluded with International Classification of Diseases (ICD-10) codes: S46.3**. Patient demographics, intraoperative data, and surgeon fellowship training were collected., I NTRODUCTION. Rupture of the distal biceps tendon is estimated to be approximately 10% of all biceps brachii ruptures. 1 Sports persons involved in competitive strength training and contact sports are more susceptible to sustain distal tendon biceps injuries. 2 Although nonsurgical management is an option in sedentary patients, the treatment of complete distal biceps ruptures in active ... , Answer: You can use 24342 (Reinsertion of ruptured biceps or triceps tendon, distal, with or without tendon graft ). This code specifies the reinsertion of ruptured biceps or triceps, distal end. Orthopedic surgeons always repair triceps distally. Another code possibility is 24341 (Repair, tendon or muscle, upper arm or elbow, each tendon or ..., CPT 29828 is a surgical code used to describe an arthroscopic procedure performed on the shoulder joint to repair an unstable biceps tendon. This procedure is typically performed to correct instability of the biceps tendon due to biceps tendonitis, inflammation of the tendon, which often accompanies other shoulder problems such as chronic ..., Sep 17, 2008 · Wiki distal bicep tendon repair. Thread starter trose45116; Start date Sep 17, 2008; Create Wiki T. trose45116 Expert. ... Medical Coding. Outpatient Facilities. Top , Best answers. 0. Aug 10, 2017. #2. I would recommend you read the "Similar Threads" listed below this panel. It basically comes down to using the Unlisted Procedure Code 27299, and pairing it to 27385 for a "Primary Repair," even though these are usually chronic tear situations. Having reviewed the possibilities, I would agree with this ...