Orthopedic Coding Alert

Iowa Subscriber

Answer: Luckily, there’s a specific CPT^® code for this type of arthroplasty. On the claim, you should report:

• 27445 (Arthroplasty, knee, hinge prosthesis (eg, Walldius type)) for the arthroplasty.
• Modifier RT (Right side) appended to 27445 to indicate laterality, if the payer requires it.
• The appropriate level E/M code from 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services. …) through 99215 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A compre­hensive examination; Medical decision making of high complexity …).
• Modifier 57 (Decision for surgery) appended to the E/M code to indicate that the E/M led to surgery.

In this procedure, the provider “replaces the damaged weight-bearing surfaces of the knee joint using a hinge prosthesis, which is an artificial implant. The aim of this procedure is to relieve the pain and disability in a severely damaged knee,” according to Codify.