CPT code 27422 – Dislocating patella reconstruction with extensor realignment

Key takeaways

CPT code 27422 reports reconstruction of a dislocating patella with extensor realignment and/or muscle advancement or release, such as a Campbell or Goldthwait type procedure.

It is a soft-tissue procedure. A medial tibial tubercle transfer is coded 27420, and an anterior tibial tubercleplasty is coded 27418.

Pair it with M22.0x (recurrent dislocation) or M22.1x (recurrent subluxation). A first-episode traumatic dislocation code alone may trigger a medical necessity denial.

An open lateral release (27425) is included in 27422, and 27427 includes the work of 27422. Neither is billed alongside it for the same knee.

Pabau, the claims and billing platform we build, tracks prior auth status, modifiers and denial patterns on 27422 claims for orthopedic practices.

CPT code 27422: Official descriptor and quick-reference data

CPT code 27422 reports reconstruction of a dislocating patella with extensor realignment and/or muscle advancement or release. It is an open soft-tissue stabilization of the kneecap. The American Medical Association maintains it in the musculoskeletal surgery section of the AMA CPT code set.

The full official descriptor reads: Reconstruction of dislocating patella; with extensor realignment and/or muscle advancement or release (eg, Campbell, Goldthwait type procedure). The procedure note must describe work on the extensor mechanism, such as a tendon transfer, a muscle advancement or a release. A note that describes moving the tibial tubercle supports a different code.

RVU values and allowed amounts change with each annual Medicare Physician Fee Schedule update. Verify current figures using the CMS Physician Fee Schedule lookup tool before billing.

What procedure does CPT code 27422 cover?

CPT code 27422 covers open realignment of the extensor mechanism to stop a patella that keeps dislocating laterally. The surgeon redirects the pull on the kneecap through soft tissue, with no cut through the tibial tubercle. The code suits sports medicine practices and orthopedic surgeons who treat patellofemoral instability.

The descriptor names two classic examples. In a Goldthwait (Roux-Goldthwait) procedure, the lateral half of the patellar tendon is split, detached and transferred medially. In a Campbell type procedure, a strip of medial capsule and fascia is used to reinforce the medial restraint.

The procedure note should show these operative steps for the claim to hold up to audit.

1. Positioning and exposure: Supine with tourniquet. An anterior or medial incision exposes the quadriceps, the patellar tendon and the medial retinaculum.
2. Assessment of tracking: The surgeon records how the patella tracks through flexion and which structures pull it laterally.
3. Release: Tight lateral structures are released where needed. This release is part of 27422 and is not billed on its own.
4. Extensor realignment or muscle advancement: The patellar tendon is split and transferred medially, or the vastus medialis obliquus is advanced over the patella. Sutures or anchors hold the new position.
5. Tracking check and closure: Patellar tracking is confirmed, followed by layered closure and a documented immobilization plan.

If the surgeon cuts and moves the tibial tubercle, the case moves to 27420 or 27418. If the patella is removed, 27424 applies. An isolated open lateral release is reported with 27425. The list below puts these checks in the order a coder should run them.

CPT 27422 vs related patellar instability codes

CPT 27422 is one of several codes for an unstable patella, and the operative technique decides between them. The closest neighbors are 27420, which moves the tibial tubercle, and 27427, which reconstructs an extra-articular ligament.

When a surgeon combines extensor realignment with an MPFL reconstruction, report one code for the knee rather than 27422 plus 27427. Choose the code that matches the documented technique and the payer’s policy. Final code selection for MPFL work varies with the documentation and the diagnosis.

ICD-10 diagnosis codes that support CPT code 27422

Medical necessity for CPT code 27422 depends on pairing it with an ICD-10-CM diagnosis code that reflects recurrent or chronic patellar instability. A single first-episode traumatic dislocation code typically does not meet payer criteria for reconstructive patellar surgery unless conservative treatment has clearly failed.

ICD-10-CM codes update every October 1. Verify that each code above remains active for the current fiscal year using the CDC/NCHS ICD-10-CM web tool before submitting claims.

Traumatic first-episode codes from the S83.0x series (dislocation of patella) generally do not support CPT 27422 alone. Surgery after a first-time dislocation needs a documented reason. Record the anatomical risk factors explicitly in the operative and pre-operative notes.

Documentation that supports a 27422 claim

A complete operative report is the strongest defense against a CPT code 27422 denial. The record must show the clinical rationale and the soft-tissue technique performed. Clean claims start before the date of service, with clean claim submission habits built into the pre-op documentation workflow.

• Confirmed recurrent patellar instability: At least two prior dislocation or subluxation events in the chart, ideally with dates and clinical notes.
• Failed conservative treatment: A physical therapy trial (typically 6+ weeks), bracing and activity modification, backed by therapy notes or referral records.
• Imaging findings: MRI of the medial restraints, plus the TT-TG distance, trochlear dysplasia grade and growth-plate status.
• Named technique in the operative report: State which extensor realignment, muscle advancement or release was done and which structures were moved. “Patellar stabilization” alone is not enough.
• Fixation of the soft tissue: The sutures or anchors used to secure the transferred tendon or advanced muscle.
• No tubercle osteotomy: Confirm that the tibial tubercle was not cut. A tubercle transfer belongs on 27420 or 27418.
• Laterality on the claim: An LT or RT modifier on every claim line, matching the operative side in the record.
• Post-operative plan: Weight-bearing restrictions and the rehabilitation protocol in the post-op note.

Prior authorization: What payers require before approving 27422

Prior authorization requirements for CPT code 27422 vary by payer and plan year. Medicare does not universally require prior authorization for musculoskeletal surgery, though many Medicare Advantage plans and commercial insurers do. Check the applicable MAC Local Coverage Determination and payer policy before scheduling surgery.

Insurance eligibility verification before scheduling surfaces authorization requirements and confirms active coverage. Most commercial payers expect these clinical criteria before approving CPT 27422.

• Recurrence threshold: Typically two or more documented dislocation or subluxation episodes.
• Conservative treatment failure: At least 6-12 weeks of supervised physical therapy, with records showing attendance and lack of adequate improvement.
• Imaging support: MRI or CT showing relevant findings, such as an MPFL tear, trochlear dysplasia or patellar tilt.
• Age and skeletal maturity: Soft-tissue realignment is a common choice when growth plates are open. Document physeal status on imaging, since it also explains why no tubercle osteotomy was planned.
• Surgeon specialty: Many plans require the operating surgeon to be a board-certified orthopedic surgeon.

Submit the authorization request with the operative plan letter, imaging reports, therapy notes and visit records. Record each submission and approval in the patient’s chart with its reference number and effective dates.

NCCI edits and bundling rules for CPT code 27422

The National Correct Coding Initiative (NCCI) publishes quarterly edits that decide which codes can be billed together. For 27422, also check the AAOS global service data, which lists the procedures included in the code. Confirm both before billing companion codes for the same knee on the same date.

NCCI edit tables update quarterly. A modifier indicator of 0 means the pair can never be unbundled. An indicator of 1 allows a modifier such as 59 or XS, with supporting documentation. Note the edition date of any table you rely on.

Medicare reimbursement rates for CPT code 27422

Medicare pays CPT code 27422 from the relative value units in the annual Physician Fee Schedule, adjusted by the geographic practice cost index (GPCI). In the 2026 schedule, 27422 carries 20.92 total facility RVUs and no non-facility rate.

For a locality-specific amount, use the FastRVU 2026 RVU lookup tool, which applies GPCI adjustments to CMS data. Rates change each January 1 and may also shift with mid-year conversion factor updates.

Common denial reasons for CPT code 27422 and how to avoid them

Denials on CPT code 27422 follow predictable patterns. A denial management workflow that tracks root causes by code shows billing teams where 27422 claims fail.

• Missing or expired prior authorization: The most common denial. Verify auth requirements at the eligibility check, track expiry dates, and confirm the code on the auth matches the billed code.
• Insufficient medical necessity documentation: Payers reject claims when the record shows one dislocation or no failed conservative treatment. Audit the chart before surgery.
• Wrong or unspecified ICD-10 code: Using an S83.0 code (traumatic dislocation) instead of M22.0 or M22.1 (recurrent) suggests the case does not meet reconstruction criteria.
• Missing laterality modifier: Medicare and most commercial payers deny 27422 without LT or RT. A pre-submission scrub catches it.
• Billing an included procedure: Adding 27425 or 27427 for the same knee duplicates work already in 27422 or its companion code.
• Technique and code mismatch: An operative report that describes a tibial tubercle osteotomy does not support 27422. Code what the surgeon documented.

How claims management software reduces denials for CPT code 27422

Most 27422 denials trace back to work done before the claim exists. An expired authorization, a missing LT or RT modifier, or an included code on the same knee all start upstream. They begin in the front office or the coding queue.

Pabau’s claims software for orthopedists keeps prior auth status, modifiers and claim history in one place. Orthopedic practices can spot bundling conflicts before submission and track denial patterns by procedure code.

Claims go out through Pabau’s integration with the Claim.MD clearinghouse, our US clearinghouse partner. It supports eligibility checks and 835 electronic remittance advice, so the billing team sees each 27422 payment or denial as it posts.

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Conclusion

CPT code 27422 rewards a precise operative note. Code the soft-tissue work the surgeon did, and move any tubercle osteotomy to 27420 or 27418.

Two habits protect most of the revenue on this code. Pair it with a recurrent M22 diagnosis, and leave 27425 and 27427 off the claim for the same knee. Getting those right before submission costs far less than appealing a denial.

Book a demo to see how Pabau helps orthopedic practices submit clean 27422 claims and track every authorization.

Continue your research

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Looking to streamline your entire revenue cycle? Revenue cycle management breaks down the end-to-end process from patient registration through final payment posting.

Reconciling the 835 files on your 27422 claims? Electronic remittance advice explains how to read ERA files and post payments and denials.

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