Orthopedic Coding Alert

Question: My surgeon is scheduling more bilateral total knee replacements (TKR), and we have a question about how to code the procedure if he is the only surgeon. In the past, I coded 27447 with modifier -RT (right side) and then 27447 with modifiers -50 (bilateral procedure) and -LT (left side) with the same date of service. Is this correct?

Amy D. Christy, RMA
East West Medical Center, Austell, Ga.

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.



Answer: A sequential bilateral TKR can be coded one of two ways, depending on carrier preference:

1. Code as two line items with 27447 (arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing [total knee replacement]) as the first line item and 27447-50 as the second line item. In each case, the units of service would be 1.

2. Code as one line item, 27447-50 with a 2 in the units of service box.

You can try to negotiate reimbursement up front with the carrier, using the argument that if you back out, or subtract the pre- and postoperative periods from the second knee replacement (10 percent and 21 percent respectively), fair reimbursement for the second knee replacement would be the peri-operative portion, or 69 percent. If successful, this would achieve a net reimbursement of 169 percent instead of the 150 percent normally associated with two procedures performed at the same operative setting.