Orthopedic Coding Alert

Answer: A sequential bilateral TKR can be coded one of two ways, depending on carrier preference:

1. Code as two line items with 27447 (arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing [total knee replacement]) as the first line item and 27447-50 as the second line item. In each case, the units of service would be 1.

2. Code as one line item, 27447-50 with a 2 in the units of service box.

You can try to negotiate reimbursement up front with the carrier, using the argument that if you back out, or subtract the pre- and postoperative periods from the second knee replacement (10 percent and 21 percent respectively), fair reimbursement for the second knee replacement would be the peri-operative portion, or 69 percent. If successful, this would achieve a net reimbursement of 169 percent instead of the 150 percent normally associated with two procedures performed at the same operative setting.