Orthopedic Coding Alert

Question: My provider conducted an orthopedic surgery on a patient’s knee that had a total replacement operation approximately one year prior. During the latest operation, the doctor put in a 15mm tibial insert into the knee of the patient and also removed hypertrophic synovium/scar from about the patella (from the previous surgery). My question is – should I use the code 27486 which includes surgery on the total knee even though the physician only worked on part of the tissue?

Pennsylvania Subscriber

Answer: The proper code that you would use for this specific operation would be 27486 (Revision of total knee arthroplasty, with or without allograft; 1 component). Also, because the surgeon only replaced the tibial poly component of the tibial prosthesis, one must append modifier 52 (Reduced service) to code 27486. This operation is known as a “revision arthroplasty,” which is conducted when a previous knee replacement is in need of mending.

This particular operation focuses on repairing a component of that earlier replacement. In this case, the physician inserts a tibial spacer to support the entire, previous knee replacement.

In most cases, even though the physician did not work on the entire knee, the tibial insert’s primary function is to strengthen the work done in the previous operation. So despite the language in the CPT® stating “revision of total knee arthroplasty,” any work done on the tissue of the knee is considered total knee work.

Remember that code 27486 includes many types of knee operations. The important thing to keep in mind is that most debridement of other tissue is essential to the arthroplasty procedure and therefore should be included in 27486.

Takeaway: Any operation that serves to revise a knee replacement, even if the physician only works on a segment of the knee, is considered “total knee.”