Orthopedic Coding Alert

Question: Our surgeon did a right knee quadriceps reconstruction and inserted a new tibial polyethylene tray in a patient who had a failed right quadriceps mechanism of total knee. The operative note describes that our surgeon replaced the tendon and patella with a donor tendon and patella. Do we report this as a tendon transplant or a revision of total knee replacement?

North Carolina Subscriber

Answer: The procedure sounds more like a quadriceps reconstruction. The term 'quadriceps mechanism' refers to the tendon of the quadriceps which has the patella embedded. 'Failed quadriceps mechanism' is not a very common complication that follows knee replacement surgery. The term implies that the quadriceps tendon is ripped off the tibial tubercle.

There are two procedures here -- 1) revision of the tibial tray, and 2) reconstruction of the quadriceps mechanism. You report 27486 (Revision of total knee arthroplasty, with or without allograft; 1 component) -52 (Reduced services...) for the total knee replacement and 27386 (Suture of quadriceps or hamstring muscle rupture; secondary reconstruction, including fascial or tendon graft) for the quadriceps reconstruction.

You need to determine if the quadriceps reconstruction is done using an autograft or allograft. Code 27386 is good to report an autograft. Sometimes, your surgeon may do an allograft reconstruction where the entire extensor mechanism including patella and quadriceps tendons are replaced using an allograft with bone block at either end. For that procedure, you may report unlisted code 27599 (Unlisted procedure, femur or knee).