# knee revision arthroplasty



## scooter1 (Dec 7, 2010)

Patient had a total knee arthroplasty (27447), but later developed infection, and the surgeon removed the prosthesis and inserted a spacer ( 27488). Now the surgeon is again 
implanting the knee prosthesis.  My question is do I code it as a revision?  That was my first choice, but then, he is not removing a prosthesis, because he had removed it in a previous procedure. Or should I again code as a 27447 . . . .    This is the first time I have come across this situation, and would be grateful for any help, as I am really confused at this point


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## nyyankees (Dec 8, 2010)

wsr1614@yahoo.com said:


> Patient had a total knee arthroplasty (27447), but later developed infection, and the surgeon removed the prosthesis and inserted a spacer ( 27488). Now the surgeon is again
> implanting the knee prosthesis.  My question is do I code it as a revision?  That was my first choice, but then, he is not removing a prosthesis, because he had removed it in a previous procedure. Or should I again code as a 27447 . . . .    This is the first time I have come across this situation, and would be grateful for any help, as I am really confused at this point



It's considred a conversion. Since there is no Knee Conversion code you would use 27447. You can add a 22 modifier if the doc documents any altered surgical field or increased difficulty.


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## BCrandall (Dec 8, 2010)

You'd want to use -58 also.


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## nyyankees (Dec 8, 2010)

bcrandall said:


> you'd want to use -58 also. :d



yes!!


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## scooter1 (Dec 8, 2010)

*I found this article. Thanks everyone for your help*

A 2-stage procedure
What happens when the surgery is not so straightforward and the procedure has to be done in stages? Assume a situation in which the surgeon removes a knee prosthesis and inserts cement or a prosthetic spacer at the time the implant is removed. If this procedure is performed outside the global period of the original surgery, it would be reported using code 27488—Removal of prosthesis, including total knee prosthesis, methylmethacrylate with or without insertion of spacer, knee. 

Six weeks later, the same surgeon brings the patient back to the operating room to remove the spacer and replace it with the definitive knee prosthesis. This procedure would be reported using code 27447-58, 22—Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty). 

Reporting either of these surgeries with the revision code 27487 would be incorrect because the CPT code that describes total knee revision surgery requires that the exchange to the definitive prosthesis be done in the same surgical session.


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