Wiki 2nd Stage TKA

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Mfox170523

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Hello.
I am needing assistance on how to code a 2nd stage total knee "revision". The patient's TKA become infected and was completely explanted with an antibiotic spacer put in during the first surgery. Now, after the infection has cleared, the same patient is returning for the second procedure to have the antibiotic spacer removed and a new total knee implanted.
Since the original total knee implant was removed, I am thinking this should be coded as a new TKA with 27447 and 11982 for removal of the spacer.
The surgeon is thinking this should be coded as a revision 27487. My thought is that since there are no total knee components left, there is nothing to revise during this second procedure.
Any and all advice would be greatly appreciated.
Thank you.
 
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You are correct, it's not 27487 because the primary, definitive TKA components were already removed and the spacer was put in. 27487 is for revision of all definitive components in the same (one) operative session. The first case would have been 27488. For stage two, where the spacer is being removed and the "final", "new" TKA is being put in, now that the infection has cleared, it's 27447- 22 (make sure the 22 is supported by the documentation with words like "revision" and explanation of the extra time, work and intensity for a revision vs. a primary TKA). Orthopedics doesn't use the 1198_ section anymore. In 2020 new codes came out for drug delivery devices. Look at code range 20700-20705 area. Keep in mind, these are add-ons and some of the arthroplasty codes either include it or they aren't the parent. There was a revision to these guidelines in 2023. Unfortunately, even though that's what the codes are for, I don't think you can do 20705 with 27447.
 
I share this a lot, I don't have any gains from it or anything, but it is really helpful. Total joints and revisions is really confusing for people and this can really help: https://karenzupko.com/bundle-1-the...lasty-from-a-to-z-fracture-care-step-by-step/

Staged arthroplasty and arthroplasty when it's anything besides primary is really confusing for folks in my experience. You want to make sure everyone's doing it the same way and be able to explain why to your providers.
 
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