Wiki Coding two stage joint revisions for infection

Create Wiki Sort by date
S

sgaribaldi

New
Messages
1
Best answers
0
We are looking for clarity in coding two stage joint revisions for infection. Previously we have been taught multiple different ways to code the same scenarios and want to educate ourselves, the authorization department and our physicians on the correct way to move forward.

If a surgeon removes a knee or hip replacement and places spacers whether they are articulating or non-articulating would it be coded with the removal codes 27091/ 27488? Or if they are articulating would the removal and placement of articulating spacers be coded as a revision 27134/27487?

For the second stage when the doctor removes the spacers and places a new prosthesis would this be coded as a revision 27134/27487 or conversion 27132/ 27447 22? Our concern is coding the placement of a hip/ knee in the second stage. The work involved reflects a revision code more than the conversion code for a hip or arthroplasty with a 22 for a knee due to the lack of current arthritis in the joint and the doctor is not reaming out bone that hasn’t been touched. The diagnosis of infection of prosthesis doesn’t support 27447 or 27132.

We appreciate any guidance.

Thank you,
Staci Garibaldi
Tri-County Orthopedics
 
0
Based on my coding experience, I have provided the responses below in blue.

If a surgeon removes a knee or hip replacement and places spacers whether they are articulating or non-articulating would it be coded with the removal codes 27091/ 27488? Or if they are articulating would the removal and placement of articulating spacers be coded as a revision 27134/27487?

*** This should be coded with the removal codes 27091/27488

For the second stage when the doctor removes the spacers and places a new prosthesis would this be coded as a revision 27134/27487 or conversion 27132/ 27447 22? Our concern is coding the placement of a hip/ knee in the second stage. The work involved reflects a revision code more than the conversion code for a hip or arthroplasty with a 22 for a knee due to the lack of current arthritis in the joint and the doctor is not reaming out bone that hasn’t been touched. The diagnosis of infection of prosthesis doesn’t support 27447 or 27132.

***If the 2nd stage is performed within the global days of 27091/27488 then we should code revision codes 27134/27487 with modifier 58 to denote that it is a staged procedure and the patient is in the global days of the 1st procedure.

***If the 2nd stage is performed after the global days, then we should code the conversion codes 27132/27447 (modifier 22 is purely based on the document support)

Hope this helps!
 
0
Always lots of debate and discussion about this. One problem is CPT has not kept up with advances and techniques in total joints. Especially when it comes to articulating spacers, revisions, etc. There are some CPT Assistant article references in the links below. I have not checked recently. A lot of the info and "guidance" from unofficial sources may not take into account the work of the revisions/altered surgical field, etc. It is going to depend on the documentation as always.
@NRaizman Dr. Raizman may know of recent input from AAOS on the topic.
If your providers are members of AAOS they can log in and have access to the AAOS Now and the coding resources on the website. https://www.aaos.org/aaosnow/

Some of these are older but the discussions are the same concept. Some are related to the shoulder but the thinking is the same.

Stage one: Removal of prosthesis with placement of abx spacers is coded 27091 (hip) or 27488 (knee). Not revision because it is staged.
Stage two: for the hip would be conversion (27132). The hip is currently the only joint with a conversion code.
Last I knew for stage two (explant spacer implant final TKA) knee it would be 27447-22. Documentation should support the 22 modifier. Depending on the documentation, you can use the T & Z codes with this, I have not had a problem. Should consider Z47.33 with the T84.____ type with last character S to explain there was an infection which lead to all this but now clear.
The revision codes (27487) would make more sense for stage 2, but that is not the guidance I have seen. The revision arthroplasty codes are for when it is in/out in the same/single surgical session.
The last I knew the articulating vs. non-articulating spacer issue was under review @ AAOS; the last CPT Assistant stance I heard was the spacer type did not matter.
We need new codes.
The drug delivery device codes (2070_) also need fixing because you can't code them in certain situations for which they really should be used. For example, it would make sense to use 27447-22 with 20705 for stage two but 20705 would deny for no parent in that case.

I disagree with the advice above from @Papitha regarding stage 2. The global days have nothing to do with how you would code the CPTs other than the modifiers used such as (58, 78).

If anyone has newer, reputable, verified source info please share! I agree, everyone (whole group, surgeon, auth, coding, billing) all need to be on the same page with this. My experience was with a very large ortho group that took complicated revision/trauma cases from all around the country/local area. We all had to agree on the coding of these. I know it is difficult when the provider feels the work they are doing is not being captured or reflected by the limitation of the codes we have to use. This was where modifier 22 came into play along with working on their documentation with them.
 
You must log in or register to reply here.
Top