Wiki UNI Knee Revised to Total Knee

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We have a patient who had a unicompartmental knee arthroplasty. The DJD progressed to the other compartment & we had to take out the UNI knee and convert to a total knee. How to code? Any suggestions would be appreciated.
 
Reference: AAOS Bulletin, October 2003: http://www2.aaos.org/aaos/archives/bulletin/oct03/code.htm

"Question:

A patient had a unicompartmental knee arthroplasty using code 27446. One year later, the patient had a revision of the hemiarthroplasty to a full arthroplasty. What codes would best represent this removal of the old compartment and then placement of a new total knee arthroplasty component?

Answer:

Normally, this would be coded 27487. The revision code includes the removal of the old prosthesis. However, depending upon documentation and the situation, this could also be coded 27447 and 27488 -51.

Note: This is not a revision of a total knee replacement. Except for removal of a partial tibial tray and femoral metal runner, the procedure is the same work as a primary total knee."
 
27487 52

By Connie L. Zeller, CPC
September 05, 2013
Partial knee replacement surgery is becoming a common treatment option knees damaged by injury or disease such as osteoarthritis because the surgery is less invasive with less postoperative pain and better range of motion than total knee arthroplasty. However, there is a possibility that a patient will need a revision of a Unicompartmental Knee Arthroplasty (UKA) to a Total Knee Arthroplasty (TKA).

CPT code 27487, Revision of total knee arthroplasty, with or without allograft; femoral and entire tibial component, should be billed with modifier 52 for a reduced service. Revision of a Unicompartmental Knee Arthroplasty is the reduced service of a Total Knee Arthroplasty, there is not a CPT code for UKA revision. Also, if prosthesis is removed, use code 27488, Removal of prosthesis, including total knee prosthesis, methylmethacrylate with or without insertion of spacer, knee. Code 27488 should not be reported with code 27487 if a new prosthesis is implanted.
 
I have a physician that has done what he calls a revision total knee 27487 but insurance is denying...they said there is another code when converting a unicompartmental to total. when I asked my physician to clarify his documentation he swears he revised the femoral and tibial components. however, he resurfaced the patellar which was not previously done. would you consider this a total with removal of previous prosthesis??? why or why not?
 
Karen78 said:
I have a physician that has done what he calls a revision total knee 27487 but insurance is denying...they said there is another code when converting a unicompartmental to total. when I asked my physician to clarify his documentation he swears he revised the femoral and tibial components. however, he resurfaced the patellar which was not previously done. would you consider this a total with removal of previous prosthesis??? why or why not?
Click to expand...
AAOS recommends 27447.22 for a conversion of a uni to total knee, but I bill 27487.52 with documentation and do not have an issue with getting Medicare to pay.

I am assuming you are dealing with a different payer here, so maybe the AAOS guideline would be better suited in this situation.
 
Hello there!
The below Coding Clinic for HCPCS 2021 3Q pages 1 - 5 indicate to use CPT 27487 for a revision from a unicompartmental to total knee arthroplasty. This is also published in the CPT Assistant, July 2013.

QUESTION 1

A patient with a previous partial lateral knee replacement (uni-compartmental) developed arthritis in the medial compartment of the patellofemoral joint in addition to collapse of the medial and lateral aspect of the tibia. As a result, she presented for a conversion of a partial knee to total knee arthroplasty. The knee was entered via the previous incision. Osteophytes were removed off the medial femoral condoyle, the undersurface of the patella was resected, and the metal femoral component was removed. Bone was resected from the distal femur.
Next, the tibial implant was removed and bone was resected from the medial aspect of the proximal tibia. This created a flat surface of the tibia. Trial components were placed, followed by placement and cementing of a short stem tibial component down an intramedullary canal for placement. The femoral component and patellar button were then placed and cemented into place. How is the revision from a previous uni-compartmental knee arthroplasty (UKA) to a total knee arthroplasty (TKA) reported?

ANSWER

Assign CPT code 27487, Revision of total knee arthroplasty, with or without allograft; femoral and entire tibial component, for the revision from a unicompartmental to total knee arthroplasty.
This is consistent with the advice published in CPT Assistant, July 2013, that CPT code 27487 with Modifier 52, Reduced Services, is the correct code assignment for a conversion from a unicompartmental to total arthroplasty.
However, it is not appropriate for the facility to report reduced services with Modifier 52 when a procedure, performed under anesthesia, has been completed as intended. Therefore, for facility reporting, CPT code 27487 is reported without a modifier.

Any guidelines issued from the AHA would supersede guidelines from the AAOS.
 
Bringing this subject up again. There's more recent info from AMA and AHA both agreeing on using 27487-52. I'm aware of the really old article from AAOS recommending 27447-22. Wondering if anyone knows if there's a more recent article or recommendation from AAOS, especially since both coding resources state the contrary. I'm honestly surprised the AMA hasn't taken this subject up again; this disconnect on code recommendations puts us, as coders, in an awkward spot for compliance.
 
christinnagle said:
Bringing this subject up again. There's more recent info from AMA and AHA both agreeing on using 27487-52. I'm aware of the really old article from AAOS recommending 27447-22. Wondering if anyone knows if there's a more recent article or recommendation from AAOS, especially since both coding resources state the contrary. I'm honestly surprised the AMA hasn't taken this subject up again; this disconnect on code recommendations puts us, as coders, in an awkward spot for compliance.
Click to expand...
I haven't checked CPT Assistant lately. There was something in 2013 about it. Have you checked for new guidance there? I would still be inclined to follow CPT Assistant with whatever they state. I can see it either way.
I wish there were better codes for a lot of the "new" and different arthroplasty procedures they do now. They need to make conversion codes for the other major joints like there is for the hip (27132).

The AMA states that a partial-to-total knee conversion should be reported with 27487 (Revision of total knee arthroplasty, with or without allograft; femoral and entire tibial component) appended with modifier 52 (Reduced services). (CPT Assistant, July 2013)
 
27487 with modifier 52 doesn't make sense to me because of how much insurance will reduce reimbursement. They'll be reimbursing for less than a new total knee (27447) and this is more work. I don't see any newer CPT Assistant articles than 2013.
 
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