Wiki TKA Coding

[sandraclark5123@gmail.com]

Pt had an injury many years ago on his knee and had plates and screws at that time. PT now needs a total knee. Physician states it should be coded as a revision but I believe it should be coded as hardware removal and total knee. Physician conducted P2P for revision code and it was denied.

 

[amyjph]

It is not a revision TKA unless the patient had a prior TKA and that is removed and replaced in the same surgical session. There is no conversion of prior knee surgery to TKA code like there is for the hip. In this case it is usually best to report the 27447 with a 22 modifier (provided the op report supports it). It would have to be documented correctly to support a 22 with information on why. The P2P was correct to deny 27487.

 

[sandraclark5123@gmail.com]

It is not a revision TKA unless the patient had a prior TKA and that is removed and replaced in the same surgical session. There is no conversion of prior knee surgery to TKA code like there is for the hip. In this case it is usually best to report the 27447 with a 22 modifier (provided the op report supports it). It would have to be documented correctly to support a 22 with information on why. The P2P was correct to deny 27487.

Thanks. I agree. I wanted someone else's opinion to give to the surgeon.

 

[amyjph]

YW. I also wanted to add, you can't take credit for the 20680 either in this case if the hardware was removed at the same anatomical site as the TKA. Such as if they had screw or plate or something in the femur, tibia or patella from a prior fracture or maybe an ACL repair or something like that. This is why the 22 is important.

See CMS NCCI Manual: https://www.cms.gov/files/document/medicare-ncci-policy-manual-2024-chapter-4.pdf
"10. There are CPT codes (20670 and 20680) for removal of internal fixation devices (e.g., pin, rod). These codes are not separately reportable if the removal is performed as a necessary integral component of another procedure. For example, if revision of an open fracture repair for nonunion or malunion of bone requires removal of a previously inserted pin, CPT code 20670 or 20680 is not separately reportable. Similarly, if a superficial or deep implant (e.g., buried wire, pin, rod) requires surgical removal (CPT codes 20670 and 20680), it is not separately reportable if it is performed as an integral part of another procedure."
"3. The code descriptors for CPT codes 20670 (Removal of implant; superficial...) and 20680 (Removal of implant; deep...) do not define the unit of service. The Centers for Medicare& Medicaid Services (CMS) allows one unit of service for all implants removed from an anatomic site. This single unit of service includes the removal of all screws, rods, plates, wires, etc., from an anatomic site whether through one or more surgical incisions. An additional unit of service may be reported only if implant(s) are removed from a distinct and separate anatomic site."