Wiki 27447/20680 vs 27487

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Karen78

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I have a physician that is doing a TKA on a patient with a previous unicompartmental component. We have questions as to whether billing the 27447-22 would be better and more likely paid or 27447, 20680 vs 27487-52? any suggestions?? we have previously billed 27447 and 20680-59 but we got denied for the 20680. I billed with the 59 modifier to a medicare replacement plan because none of the X{EPSU} modifiers seemed appropriate. any help would be greatly appreciated.
 
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I would not use -52 modifier in this case because the physician is removing and replacing a femoral component and a tibial component. 20680 is basically meant to be used on its own or if the hardware is in a separate anatomical area. You need to pull up and read the 2017 CMS NCCI Surgical Policy Manual. Many answers are there.
 
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Karen78 said:
would you use the 52 modifier? and if so, where do you find documentation that would support that? I am just trying to get my ducks in a row to show my Dr.
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Here is a screenshot of my Coder software. They show that they are inclusive to one another. The only way you could bill both codes on the same claim is if the hardware removal was for a different body part. In that case you would bill a 59 modifier on 20680.


4343
 
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lburgos31 said:
Here is a screenshot of my Coder software. They show that they are inclusive to one another. The only way you could bill both codes on the same claim is if the hardware removal was for a different body part. In that case you would bill a 59 modifier on 20680.


View attachment 4343
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What coding software are you using? My office is floating around ideas on purchasing one so I would love to hear your opinion.
 
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Karen78 said:
I have a physician that is doing a TKA on a patient with a previous unicompartmental component. We have questions as to whether billing the 27447-22 would be better and more likely paid or 27447, 20680 vs 27487-52? any suggestions?? we have previously billed 27447 and 20680-59 but we got denied for the 20680. I billed with the 59 modifier to a medicare replacement plan because none of the X{EPSU} modifiers seemed appropriate. any help would be greatly appreciated.
Click to expand...
AAOS recommends 27447.22 for the uni to total knee conversion; Margie Vaught recommends 27487.52 because you are revising one component

As previously stated, 20680 is bundled and may only be billed if it was done on another anatomic site. Also, 20680 applies to deep (buried) pins, wires, etc. not a prosthesis and would not be correct to code in this instance. I personally bill 27487.52 and submit with documentation and don't have a problem getting them paid. It may take longer to receive the payment, but that is almost always the case when billing a 22 or 52 modifier.
 
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