1. User id : 28709 Posted 11 months ago #
   

   I need help...
   Patient had a total knee replacement in July 2011 and on October 21, 2011 patient went in for manipulation of knee (27570 78) dx 718.46
   United Healthcare paid the claim then came back and now asking for a refund stating: Based on the information provided, this service is unproven for the diagnosis billed and is not covered. No benefits are payable for this expense for this service To be considered for coverage, scientific evidence must be submitted that meets the standards described in your benefit plan language that demonstrates the safety and effectiveness of this service for your particular condition.

   Thank You for your time,
   Cindy
   Center For Orthopaedic Surgery and Sports Medicine

2. SuperCoder Posted 11 months ago #
   

   The global surgery package is 90 days and it includes synovectomy, removal of loose bodies, debridement of the knee, meniscectomy, lateral retinacular release, ligament or capsular release or reconstruction, manipulation of knee and arthrotomy.In short, do not try to code separately for any of those procedures or it will constitute unbundling.

   When the TKR fails: There are separate CPT codes for revision surgery. If the failure of the TKR requires a revision to only one component, use 27486 (revision of total knee arthroplasty, with or without allograft; one component). For the entire knee, use 27487 (revision of knee arthroplasty, with or without allograft; femoral and entire tibial component).

   If the knee fails during the global period (for 27447), use modifier -78 (return to the operating room for a related procedure during the postoperative period) with 27487 and always send a copy of the operative note.

   The ICD code for the revision depends on the reason for the failure. For example, it might be a loose femoral component (996.4, mechanical complication of internal orthopedic device, implant, and graft) or infection (996.66, infection and inflammatory reaction due to internal joint prosthesis). The correct V code to reflect the patients health status (V43.65, replaced knee joint) should be recorded."

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