Wiki Synovecotmy and Polyethylene Exchange, Knee

[KStaten]

Greetings!

When a synovectomy (or I&D) is performed with a polyethylene exchange, (yet neither the tibial nor femoral components are removed), which code is most appropriate? From what I am seeing, we are to use the revision code with the -52 modifier. (?) Is this correct?

27486 - Revision of total knee arthoplasty, with or without allograft; 1 component
Modifier -52 Reduced Services

Thanks!

 

[KStaten]

An interesting point has been brought to my attention, as another coder has suggested that the modifier -52 should NOT be appended, and apparently, all of the surgeries billed without the modifier for the polyethylene exchange have paid at her company without any problem.

Upon further research, I discovered that The Optum360 Coding Companion Orthopaedics- Lower: Hips & Below (2020) states "In 27486, one of the femoral or tibial components OR the polyethylene liner is removed as determined by the physician." From that, it sounds as though it could be interpreted as the polyethylene liner is considered as a component by itself. Technically, the code itself does not state "tibial or femoral," but leaves it at the vague "one component." There is no mention of appending -52, as it sounds as if the liner is justified as being "one component," hence meeting criteria for the code 27486- Revision of total knee arthroplasty, with or without allograft; 1 component.

As always, thoughts, input, and suggestions are greatly appreciated!

 

[Orthocoderpgu]

Code 27486-52 is the most appropriate if they are just replacing the poly. Keep in mind lesser procedures, such as I&D, will bundle in the same area as a larger procedure.

 

[KStaten]

Code 27486-52 is the most appropriate if they are just replacing the poly. Keep in mind lesser procedures, such as I&D, will bundle in the same area as a larger procedure.

Thank you! It's always nice to have reassurance!

 

[KStaten]

I hate to be a pest, but I am still being questioned about this due to the updated information from my previous comment above. I still feel that it should be 27486 -52, but would like reassurance once again so that I may present this when questioned. As we know, there are many gray areas in coding when left up to interpretation, and, as coders, it is always helpful when we have others who either help us argue our points OR correct us so that we don't continue mistakes. Thank you all! I appreciate and value your input very much!