Orthopedic Coding Alert

Question: My doctor did a knee arthrotomy with irrigation and debridement. She also replaced the polyethylene. She wants to code this as 27310 and 27488-78-52-51. Because she didnt remove the entire prosthesis, how should we account for this in our coding? Which diagnosis codes should we use?

Colorado Subscriber

Answer: Your surgeon has the right idea with modifier -52 (reduced services), but try a different approach to the codes. The advent of the new modular joint components confused a lot of coders. Frequently, revision joint arthroplasties are performed and only the worn parts (i.e., the acetabular liner or tibial articulating surface) are replaced rather than the entire component. This presents one of the few opportunities for orthopedists to use modifier -52. Because your surgeon is revising the polyethylene only and not the entire component, report 27486 (revision of total knee arthroplasty, with or without allograft; one component) with modifier -52 appended. A brief letter is required whenever modifier -52 is used.

As for diagnosis codes, use the appropriate code for complications related to prosthetic implants (996.4, mechanical complication of internal orthopedic device, implant, and graft; 996.66, infection and inflammatory reaction due to internal prosthetic device, implant, and graft; due to internal joint prosthesis; or 996.77, other complications of internal [biological] [synthetic] prosthetic device, implant, and graft; due to internal joint prosthesis) with V43.65 (organ or tissue replaced by other means; knee) as the secondary diagnosis code.