# Coding Single Stage Revision left total knee arthroplasty



## taylorchurch06 (Feb 26, 2018)

I am looking for some advice. One of our providers performed a single stage revision left total knee arthroplasty with polyethylene exchange, irrigation & debridement and implantation of antibiotic impregnated beads. We billed the revision as 27486 (Revision of total knee arthroplasty, 1 component). The insurance is stating that this needs to be billed as 27310 for Arthrotomy for infection and states that the poly exchange is incidental. The 27310 does not seem correct to me since one component was actually removed and replaced with a new one. Any advice?


----------



## hblakeman (Feb 26, 2018)

*Conflicting advise*

There was this in the 3/3/2010 Ortho Coding Alert:

"Question: A patient is 18 months past total knee replacement that became septic. Our orthopedist scheduled surgery and completed a revision. The operative report documents "arthrotomy,total synovectomy, pulsatile irrigation and debridement, tibial polyethylene liner exchange." How should I code the surgery?

Answer: You\'ll report 27486 (Revision of total knee arthroplasty, with or without allograft; 1 component). The "exchange" in your surgeon's notes indicates he placed a new tibial poly. Append modifier 52 (Reduced services) because your surgeon retained the existing tibial base plate and only exchanged the poly instead of inserting a complete implant."

However, some feel you should code as arthrotomy.


----------



## hmlsmith (Jul 7, 2020)

"Revision Arthroplasty" codes are typically for complications such as loosening, excessive wear, malposition, etc.
When treatment is for an infection, CPT 27310 is correct.  The poly needs to be removed to get access to the compartments of the joint for the I & D.  
Since the poly cannot be reinserted (not sterile), a new sterile poly is used - making it inclusive / incidental to the I & D.


----------

