Wiki 27486 or 27438 in an ASC

[Henson65]

OP note is as follows:

The lateral iliotibial band was released. The patella was then mobilized and able to be positioned in a neutral manner. The patella was then revised with resection of the patellar component with excellent preservation of the bone. All cement debris was removed. The patella resurfacing was then performed with a 37-mm patellar component. The patella was medialized appropriately.

I'm torn because this note refers to a patella component but then talks about resurfacing of the patella. In my experience, providers don't normally resurface implants they would simply replace them so I would lean to the patella wasn't replaced during the previous knee surgery. Because of the latter, I would lean towards 27438 but am still questioning if the patella had actually been previously replaced. This was all performed in an ASC setting and I know 27486 is not reimbursable, but the 27438 is. Would you code one way or another or reach out to the provider to confirm if the patella had been previously replaced....if it had would you code as 27486?

Any help would be greatly appreciated.

 

[meghanhannus]

Hello Hensen65,

I don't think CPT 27486 is the correct code as it is for revision of a total knee arthroplasty, one component (one of the femoral or tibial components are not mentioned in addition to patella in the documentation). I think this is a revision of a prior patellar componet as the documentation mentions removing cement and the old patellar component and then resurfacing and placing another patellar component. I agree with CPT 27438(RT/LT) only for this procedure and believe that the removal of the old patella component is not separately billable. It wouldn't do any harm to double check with the provider as well