# Patellofemoral arthroplasty - I need advice



## dgerry (Feb 14, 2013)

I need advice - how do you code for this?  I've seen 27442 and 27438, 59 used but I'm not sure if that is correct.  Any help would be greatly appreciated!


----------



## nyyankees (Feb 15, 2013)

dgerry said:


> I need advice - how do you code for this?  I've seen 27442 and 27438, 59 used but I'm not sure if that is correct.  Any help would be greatly appreciated!



I think your best bet is 27438-22 and I know Orthonet requests this for the procedure. What you are really doing is the patella arthroplasty (27438) and 1 of the femoral condyles but not both. The 22 modifier captures the femoral portion. My doc likes 27447-52 which is in the ballpark but not excatly there. You could also use the Unlisted code (which nobody likes) as I believe AMA is leaning towards that.


----------



## dgerry (Feb 15, 2013)

Thanks for your advice!


----------



## codegirl0422 (Oct 3, 2017)

Patellofemoral Joint Replacement

Coding Clinic for HCPCS, First Quarter 2016: Page 4 

Coding advice contained in this issue is effective with procedures/services provided after April 15, 2016, unless otherwise noted. 

QUESTION 4

Patient presents to have a left patellofemoral replacement. The surface of the femur was prepared for insertion of the femoral trochlear implant. Then the surface of the patella was resected for the insertion of the patellar button. The bone cement was mixed and the femoral trochlear implant was cemented into place along with the patellar button component and held into place until cement hardened. There was good alignment and the area was closed. We want to report 27438 and 27442 but an NCCI edit exists. How is a patellofemoral joint replacement reported? 

ANSWER

CPT code 27438, Arthroplasty, patella; with prosthesis, would be reported for the procedure performed regardless of whether 1 or 2 components were implanted. Please note that it would be inappropriate to report CPT code 27442, Arthroplasty, femoral condyles or tibial plateau(s), knee, separately as both procedures were performed in the same knee joint.


----------



## AReilly (Aug 9, 2021)

Coding Correction: Reporting Patellofemoral Arthroplasty With Trochlear Resurfacing 
CPT® Assistant February 2021 / Volume 31 Issue 2

In a question under the heading, “Surgery: Musculoskeletal System,” in the Frequently Asked Questions (FAQs) section on page 8 of the June 2016 issue of CPT ® Assistant, the answer incorrectly stated that it is appropriate to report code 27442 for patellofemoral arthroplasty and unlisted code 27599 may be reported for trochlear resurfacing (see original FAQ below). *Upon further analysis by relevant specialty societies, it was determined this recommendation was incorrect; *instead, it would be appropriate to report unlisted code 27599, Unlisted procedure, femur or knee, for all of the work described in the entire procedure (see revised answer to the FAQ). Therefore, the advice in this coding correction supersedes prior advice given in the June 2016 FAQ.

The revised answer for the FAQ is as follows:

Question: When the physician performs a “patellofemoral” arthroplasty in which the prosthesis is inserted into the trochlear groove (and not into the femoral condyles), is it still appropriate to report code 27442, Arthroplasty, femoral condyles or tibial plateau(s), knee? Or would code 27599, Unlisted procedure, femur or knee, be reported because there is no CPT code that describes trochlear replacement?

Answer: To clarify, code 27442 is used to report procedures performed before successful knee arthroplasties, in which surgeons would resurface the femur to address the femorotibial joint, ie, not the patellofemoral joint, are performed. *Therefore, it would be appropriate to report unlisted code 27599, Unlisted procedure, femur or knee, for the entire procedure. *Patellofemoral arthroplasty involves greater effort and more work than is needed for the procedure represented by code 27438, Arthroplasty, patella; with prosthesis, because a trochlear implant is added. However, it represents less work than is required for the procedure reported with code 27446, Arthroplasty, knee, condyle and plateau; medial OR lateral compartment. Note that code 27446 does not include patellofemoral arthroplasty. Thus, there is no CPT code that reflects the work performed in this clinical scenario. When reporting an unlisted code to describe a procedure or service, it will be necessary to submit supporting documentation (eg, procedure report) along with the claim to provide an adequate description of the nature, extent, and need for the procedure, as well as the time, effort, and equipment necessary to provide the service.


----------

