Wiki Knee Revision 27487 & Corresponding Diagnosis Codes?

[KStaten]

Hello, Everyone!

I have noticed a few denials for the CPT code 27487 (Revision of total knee arthroplasty, with or without allograft; femoral and entire tibial component) when linked to T84.84XA (Pain due to internal orthopedic prosthetic devices, implants and grafts) and the corresponding Z-code, Z96.651 or Z96.52 (Presence of right/left artificial knee joint).

In some cases, the patient does not have component loosening or wear, nor injuries, such as fractures; they simply have pain and/or leg discrepancies the doctor has determined to be caused my the implants. Is this diagnosis code insufficient or am I doing missing something? I appreciate and value your input!

Thank You in advance!
Kim

 

[clark.amy86]

T84.012A	Broken internal right knee prosthesis, initial encounter
T84.012D	Broken internal right knee prosthesis, subsequent encounter
T84.012S	Broken internal right knee prosthesis, sequela
T84.013A	Broken internal left knee prosthesis, initial encounter
T84.013D	Broken internal left knee prosthesis, subsequent encounter
T84.013S	Broken internal left knee prosthesis, sequela
T84.022A	Instability of internal right knee prosthesis, initial encounter
T84.022D	Instability of internal right knee prosthesis, subsequent encounter
T84.022S	Instability of internal right knee prosthesis, sequela
T84.023A	Instability of internal left knee prosthesis, initial encounter
T84.023D	Instability of internal left knee prosthesis, subsequent encounter
T84.023S	Instability of internal left knee prosthesis, sequela
T84.032A	Mechanical loosening of internal right knee prosthetic joint, initial encounter
T84.032D	Mechanical loosening of internal right knee prosthetic joint, subsequent encounter
T84.032S	Mechanical loosening of internal right knee prosthetic joint, sequela
T84.033A	Mechanical loosening of internal left knee prosthetic joint, initial encounter
T84.033D	Mechanical loosening of internal left knee prosthetic joint, subsequent encounter
T84.033S	Mechanical loosening of internal left knee prosthetic joint, sequela
T84.052A	Periprosthetic osteolysis of internal prosthetic right knee joint, initial encounter
T84.052D	Periprosthetic osteolysis of internal prosthetic right knee joint, subsequent encounter
T84.052S	Periprosthetic osteolysis of internal prosthetic right knee joint, sequela
T84.053A	Periprosthetic osteolysis of internal prosthetic left knee joint, initial encounter
T84.053D	Periprosthetic osteolysis of internal prosthetic left knee joint, subsequent encounter
T84.053S	Periprosthetic osteolysis of internal prosthetic left knee joint, sequela
T84.062A	Wear of articular bearing surface of internal prosthetic right knee joint, initial encounter
T84.062D	Wear of articular bearing surface of internal prosthetic right knee joint, subsequent encounter
T84.062S	Wear of articular bearing surface of internal prosthetic right knee joint, sequela
T84.063A	Wear of articular bearing surface of internal prosthetic left knee joint, initial encounter
T84.063D	Wear of articular bearing surface of internal prosthetic left knee joint, subsequent encounter
T84.063S	Wear of articular bearing surface of internal prosthetic left knee joint, sequela
T84.092A	Other mechanical complication of internal right knee prosthesis, initial encounter
T84.092D	Other mechanical complication of internal right knee prosthesis, subsequent encounter
T84.092S	Other mechanical complication of internal right knee prosthesis, sequela
T84.093A	Other mechanical complication of internal left knee prosthesis, initial encounter
T84.093D	Other mechanical complication of internal left knee prosthesis, subsequent encounter
T84.093S	Other mechanical complication of internal left knee prosthesis, sequela
T84.53XA	Infection and inflammatory reaction due to internal right knee prosthesis, initial encounter
T84.53XD	Infection and inflammatory reaction due to internal right knee prosthesis, subsequent encounter
T84.53XS	Infection and inflammatory reaction due to internal right knee prosthesis, sequela
T84.54XA	Infection and inflammatory reaction due to internal left knee prosthesis, initial encounter
T84.54XD	Infection and inflammatory reaction due to internal left knee prosthesis, subsequent encounter
T84.54XS	Infection and inflammatory reaction due to internal left knee prosthesis, sequela

*ICD-10-CM diagnosis codes Z96.651, Z96.652 and Z96.653 should not be used as a primary diagnosis code when billing for a revision of a total knee replacement. They should be used in conjunction with one of the following diagnoses: M97.11XA-M97.12XS, T84.012A-T84.013S, T84.022A-T84.023S, T84.032A-T84.033S, T84.052A-T84.053S, T84.062A-T84.063S, T84.092A-T84.093S, T84.53XA-T84.54XS.

This is part of the LCD list for 27486/27487 from Medicare and T84.84XA is not a covered diagnosis. I have encountered the same denial as you in the past and if the documentation in the patient chart was sufficient, I would update the diagnosis to a better suited one from the LCD list. I am typically more inclined to use T84.092-3A if there is mention of a potential complication with the prosthesis itself, but no detail on what that may be and pain being the only definitive diagnosis. As always, go with your gut and if you are still unsure query the physician.

diagnosis codes, diagnosis coding