Wiki Knee Arthoplasty

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thomasgail

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Hi all! I am hoping for any help you may have. I am fairly new to Orthopaedic surgery and I am seeing insurance denials of some of the cpt codes we are billing stating they are included with another procedure. For instance, my doctors use 27487 for total knee arthoplasty for tibial component but also use code 27335 which is Arthrotomy, with synovectomy, knee; anterior AND posterior including popliteal area. Can we justify two different areas for the tibial then the popliteal or is cpt 27335 truly part of 27487? Here is a full example for codes used often:

27487
included procedures denied:
27335
27310
27425
12036
27324
11406
15273-(this code denies as not covered)
15274-(this code denies as not covered)

Any help is appreciated! (insurance for this example is Aetna Medicare) Thank you! :)
 
The only code out of that bunch that does not bundle with the 27487 would be 11406. But, without knowing what the op report shows was performed - I couldn't say whether or not that 11406 is justified. Also, you stated that 27487 was used for total knee arthroplasty of the tibial component... I assume this is a revision?
 
Your smaller procedures bundle into joint replacments

Keep in mind that performing a knee replacement, or revision is a major surgery. The surgeon can't perform either without opening the joint capsule (arthrotomy); so that is included. Many times the surgeon will have to do several other smaller procedures to make sure that the knee if fully prepared for the implants such as removing osteophytes. Unless the surgeon does something that is really not related to the knee replacement, it will bundle. I have coded thousands of these procedures and it is so rare to see any other smaller procedure not bundle. It really would have to be a separate issue and something that is not "in preparation" for the knee replacement to be performed.
 
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From one orthopedic surgery coder to another, I highly recommend Global books (Complete Global Service Data for Orthopaedic Surgery Books by AAOS)-- I refer to them A LOT. They are different than the companion books published by Optum. Pricey, but worth every penny, especially when it comes to appealing denials.

CPT 27487- this procedure includes,
Synovectomy (partial or complete)
Removal of loose bodies
Debridement
Internal Fixation
Ligament or capsular release, repair or reconstruction
Manipulation- Knee
Removal or previously inserted prosthesis
Arthrotomy knee

This only thing listed as not included is insertion, removal or exchange or nonbiodegradable drug delivery (11981-11983)
 
Did you buy your books or did your office buy them?

Peace
?_?
I wish I had access to AAOS guidelines but really cannot afford the monthly subscription.
 
Hschimme said:
From one orthopedic surgery coder to another, I highly recommend Global books (Complete Global Service Data for Orthopaedic Surgery Books by AAOS)-- I refer to them A LOT. They are different than the companion books published by Optum. Pricey, but worth every penny, especially when it comes to appealing denials.

CPT 27487- this procedure includes,
Synovectomy (partial or complete)
Removal of loose bodies
Debridement
Internal Fixation
Ligament or capsular release, repair or reconstruction
Manipulation- Knee
Removal or previously inserted prosthesis
Arthrotomy knee

This only thing listed as not included is insertion, removal or exchange or nonbiodegradable drug delivery (11981-11983)
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Hello! Could you please clarify if 27486, 27334-59 can be billed together? What is included/bundled in 27486 per AAOS guidelines? I will appreciate your help! Thank you.
 
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