# left knee CPT code help



## Jennifer17 (Apr 21, 2017)

Left knee arthrotomy, irrigation and debridement, synovectomy plus polyethylene liner exchange plus insertion of antibiotic beads

Please advise.


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## mason63 (Apr 21, 2017)

Report 27486-52 for the exchange, with 11981 for the insertion of the antibiotic beads. I believe the I & D and synovectomy are included with the 27486.


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## Jennifer17 (Apr 21, 2017)

Thanks!


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## AlanPechacek (Apr 25, 2017)

I disagree with the above response.  Without any other information provided, it is clear to me that the surgeon was treating an infected knee joint and arthroplasty.  This does not qualify as a "Revision " procedure.  The procedure performed was an Incision, Exploration, Debridement (including Synovectomy), and Drainage of an infected knee joint, 27310.  It is "customary" during this procedure to remove the Polyethylene Tibial Component to allow access to the medial and lateral posterior compartments of the joint for debridement/synovectomy.  Since the component removed cannot be properly "sterilized" for reinsertion, it is also "customary" to insert a new, sterile component.  
The use /submission of 27486 for Revision of Total Knee Arthroplasty, single component, can probably be done with Modifier 52 for Reduced Procedural Service, but it may be rejected/denied.

The use of a "Revision Arthroplasty" procedural code pretty much is restricted to other (mechanical) complications such as loosening, excessive wear, malposition, etc., but not to an infection of this nature, acute to subacute in duration.  For chronically infected arthroplasties with involvement of the entire joint and the bone, then the most common method of treatment is to remove all the components and do an extensive debridement, fill the joint with an antibiotic cement spacer, then at some later date do a Revision Arthroplasty of the entire joint prosthesis.  This is called a "Two Stage" Revision for infection.

In this particular case, the implantation of the antibiotic beads, 11981, into the joint is probably allowable with a modifier (either 22 or 51).  Personally, I have had to do the treatment procedures for infected knee arthroplasties as done in this case, but I have never used the beads, which will require another procedure in the future to remove them.

I hope this clarifies what was done and for what reasons.

Respectfully submitted, Alan Pechacek, M.D.
icd10orthocoder.com


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