Avoid Denials for Total Knee Replacement Procedures- Published on Mon, May 01, 2000
"Total knee replacement presents a double challenge for codersmodifiers must be used correctly and the global surgical package must be understood.
The scenario: An obese 45-year-old woman suffering from end stage (degenerative) arthritis endured as much pain and loss of mobility in her knees as she could tolerate. Despite her relatively young age and the difficulty she would have during rehabilitation because of her weight, she and her orthopedic surgeon (OS) agreed during an office visit that she should have a total knee replacement (TKR) in each knee.
To provide the best chance of successful rehabilitation, the OS replaces only the right knee. After the woman regains function in that knee, the OS will replace the left knee.
The diagnosis for the womans condition is degenerative arthritis, 715.96 (osteoarthrosis; lower leg). Modifier -57 (decision for surgery) should be attached to the appropriate level of established patient evaluation and management (E/M) service (99211-99215) that resulted in the initial decision to perform surgery. If the womans obesity is of unspecified origin (278.00) and the OS records the condition as contributing to or exacerbating her knee problems, it could be listed as a secondary diagnosis.
The coding: Pat Strubberg, CPC, processing team manager at Physician Data Management in St. Louis, shares details about coding for TKR and the potential pitfalls.
A total joint replacement is sometimes called an arthroplasty, she explains. Arthroplasty is defined as reconstructive surgery of a joint to restore motion. But not all arthroplasty involves all the components required to make it a TKR in the lexicon of CPT. A knee replacement can be a total knee or a single component, says Strubberg. The components are medial and lateral. It is important to read the operative report to ensure that it is truly a total knee.
The correct code for a total knee replacement is 27447 (arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing [total knee replacement]). If only a medial or lateral component is the target of the replacement (unicondylar knee replacement), use 27446 (arthroplasty, knee, condyle and plateau; medial OR lateral compartment).
Special Coding Considerations
Modifiers: Strubberg reminds, It is appropriate to use modifier -RT (right side) or -LT (left side) when coding 27447. If the knee replacement is bilateral, use modifier -50 (bilateral procedure) and double the normal fee. Many carriers will reimburse only the bilateral procedure at 150 percent of the single one.
Global period: 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, explains Strubberg. In short, do not try to code [...]