# Revision of Tibial & Patellar Polyethylene Component



## Sara82 (Apr 14, 2011)

Im pretty sure Ive read that the synovectomy and debridement would be included in the revision. Im just not sure how I would code the revision - I was thinking maybe 27486-52 ? Below is a brief outline of the Op Report. Any other suggestions?

OPERATION PERFORMED:
Left knee open complete synovectomy with an irrigation and
debridement of an infected total knee with a revision of the
tibial polyethylene component and patellar polyethylene
component.

A midline
incision was made over the patient's prior scar.  I made a medial
arthrotomy, and upon making a medial arthrotomy, there was
purulent fluid which basically exploded out of the knee.  I took
new cultures once again as it was interesting that as we went
distal, the medial soft tissue was not healed to the proximal
medial tibia, or it had undermined with the infection and then
the infection looked like it almost went under the patellar
tendon, most of the tendon was intact certainly, but I actually
placed a bone staple into the tibial tubercle, just to protect it
because of the revision, I did not want it to avulse and then I
would take it off at the end.  I made a medial parapatellar
arthrotomy.  I was extremely careful of the neurovascular
structures throughout the case.  I initially performed a complete
synovectomy going all over the entire knee just very carefully
and meticulously using curettes and rongeurs as well as the Bovie
removing the inflamed synovium.  I was very careful posteriorly.
 I removed the patellar polyethylene, and I literally used a soft
brush to just try to scrub any potential glycocalyx from the
prosthesis, but being careful not to scratch it of course.  I
then removed the polyethylene from the tibia, and then was able
to do the same thing on both the femoral and tibial prostheses as
well as posteriorly.  I was very careful posteriorly of course.
 I used multiple liters of antibiotic-impregnated irrigation
fluid to pulse lavage the knee throughout the entire case.  Once
everything was very clean, we changed all the gloves.  We changed
the suction tip.  I then placed a new 12.5 tibial polyethylene
which was the same size that was removed, and this was double
checked, and the same on the patella polyethylene.  The revision
of the patellar polyethylene and tibial polyethylene component
was made, but the metal itself was left alone because it was well
fixed.  The staple in the patellar tendon was removed.  The
patellar tendon was well fixed.  It was just a little bit of
undermining medially which looked like it was just due to the
infection was unusual.  2 drains were placed laterally, and the
tourniquet was let down.  Hemostasis was meticulously achieved.


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## kadensmom (Apr 18, 2011)

I agree...27486-52 since only the liners were replaced and the metal was left alone 

Kara Hawes, CPC


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## nyyankees (Apr 18, 2011)

kadensmom said:


> I agree...27486-52 since only the liners were replaced and the metal was left alone
> 
> Kara Hawes, CPC



you don't have to use the 52 modifier as I leave it up to the docs. They usually leave the 52 mod off for the liner exchange...


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## kadensmom (Apr 18, 2011)

Unless they are replacing the entire femoral or tibial component, or there is modifier 22-like difficulty, I think that 52 should be appended, and send an operative report/letter to the payer telling them what you're reporting and how much you'd like to be paid. I'm pretty sure there is a Pink Sheets or Orthopedic Coding Alert article on this...a no-complications liner exchange should be reported as 27486-52 as the liner does not qualify as an entire component, and if it's a difficult exchange for some reason (difficulty removing, lodged under a component, etc.) that does justify 27486 without a modifier. I'm definitely interested in seeing any documentation that says a simple liner exchange meets the definition of 27486 without reporting reduced services...that would make my life a lot easier


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## Sara82 (Apr 18, 2011)

Thank you both for your help


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## nyyankees (Apr 18, 2011)

kadensmom said:


> Unless they are replacing the entire femoral or tibial component, or there is modifier 22-like difficulty, I think that 52 should be appended, and send an operative report/letter to the payer telling them what you're reporting and how much you'd like to be paid. I'm pretty sure there is a Pink Sheets or Orthopedic Coding Alert article on this...a no-complications liner exchange should be reported as 27486-52 as the liner does not qualify as an entire component, and if it's a difficult exchange for some reason (difficulty removing, lodged under a component, etc.) that does justify 27486 without a modifier. I'm definitely interested in seeing any documentation that says a simple liner exchange meets the definition of 27486 without reporting reduced services...that would make my life a lot easier



what's your email? this pink sheet is why I ask my docs for their final decision on the 52 mod..


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## kadensmom (Apr 18, 2011)

khawes@medwebsolutions.net - Thanks!


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## jdemar (Apr 19, 2011)

I  agree with the -52 modifier for reduced services, as referenced in the Orto Pink Sheet and also if any addtional degree of complexity you may not need it @ all.  I would agree to have the Dr. review for his service provided.


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## nyyankees (Apr 19, 2011)

jdemar said:


> I  agree with the -52 modifier for reduced services, as referenced in the Orto Pink Sheet and also if any addtional degree of complexity you may not need it @ all.  I would agree to have the Dr. review for his service provided.



I think it's your best bet to ask your doc as they could give you a hard time if you didn't give them that option.


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## jdemar (Apr 19, 2011)

Most definitely!


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