Orthopedic 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?

Virginia Subscriber

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.