Wiki Knee replacement because of Fracture

[Clmarasco]

What CPT code do I use for a fracture repair when the procedure will be knee replacement? There is a code for this on Hips (27236). What do I use for the knee? The fracture code does not meet the LCD.

 

[OCD_coder]

You did not share enough information to help you much more than cursory, for example what is the fracture type or what LCD you are referring to as to what carrier. I have included MCR's NCD which does allow for fractures to be repaired with a TKA procedure.

Indications

Total Knee Replacement (TKR) surgery must meet one ....... of the following Distinct structural abnormalities such as:

A.Distal femur fracture;
B.Proximal tibia fracture;
C.Malignancy of the distal femur, proximal tibia, knee joint or adjacent soft tissues; or
D.Avascular necrosis of the knee;

http://www.cms.gov/medicare-coverag...Ver=1&Date=&DocID=L32971&bc=iAAAAAgAIAAAAA==&

 

[Clmarasco]

The patient fell and had severely comminuted lateral distal femoral fractures
with preexisting severe osteoarthritis of her bilateral knees. She was also
found to have an impaction fracture of the anterolateral left proximal tibia and
anteromedial right proximal tibia.
The LDC is #L33494 for Medicare, I'm in Northern California. the NDC you listed is for Alabama......
To make matters worse, one of my surgeons is on the right side with his assistant & another one is on the left with... his assistant.

 

[OCD_coder]

A tibia fracture is clearly outlined as supporting medical necessity in the LCD, a co-surgeon is allowed for the TKA (27447). Each surgeon would document what they perform in their own Op Report.

Total Knee Arthroplasty (TKA)

Indications:

Noridian will consider total knee replacement surgery medically necessary when one or more of the following criteria* are met:

Advanced joint disease demonstrated by:
Proximal tibia fracture