Wiki HELP - CPT for total femur

Create Wiki
R

RebeccaMoney

Expert
Messages
295
Location
LEES SUMMIT, MO
Best answers
0
Unlisted 27299 OR 27599? If so, would the comparison code be 27447 or 27130? Pt has a history of Right Total hip , I&D due to infection and then revision of the femoral stem. According the the xrays there is not adequate bone at the proximal femur so the need for surgery for a total femur as patient continues to have pain. Can anyone help?
Thank you,
 
I have a patient with osteosarcoma with mets , we are doing Total femur replacement. Patient has
previously had a knee replacement, however is now experiencing loosening. CPT guidance would
be appreciated and hopefully this will not be unlisted since patient has Medicaid. Hope everyone
had a great Coder's Day!
 
Would it be another revision of femoral component surgery, 27138? If that patient already has a prosthetic hip and needs a new femoral component due to pain.
 
No, a total femoral replacement is a limb salvage procedure (maybe the patient had major trauma and is facing an amputation) and/or for things like osteosarcoma. These are very complicated procedures. It's not just a revision as described in 27487 or 27138 for example. And, it's not just 27447 or 27130. Look at the components in this link as an example, it's a segmental system.

Do some research and look at what is done during some of these cases.
www.aaos.org

AAOS OVT - Total Femur Arthroplasty for Complex Periprosthetic Fracture

www.aaos.org

I would suggest working with your provider and revenue cycle leaders to decide on the codes to be used, comparison codes and pricing. The best choice may be unlisted but there could be options to use both the revision TKA & revision THA as a combination. However, nothing in those CPT accounts for the entire femur being replaced. A 22 modifier may be appropriate. It's dependent on what the patient has in place already too, some already have a THA, TKA or both while some may have a total femur but have native joints. It's also dependent on the exact procedures performed during the case as they will be different for each patient. These need to be tracked properly to make sure adequate payment is received and usually medical records will be requested.
 
We have providers that do this. We code it based on what was done at the joints (revision of hip and/or knee, one component vs two components; or could be a revision of one joint and a new arthroplasty of another if the patient still had a native joint) and then we additionally use an unlisted code that we created RVU's for to account for the removal and replacement of the femur. As Amy said, these are major surgeries and just coding for the hip and knee doesn't account for and cover the whole procedure done.
 
You must log in or register to reply here.
Top