Wiki 27487 and soft tissue mass excision?

[hdavis34]

I wanted to ask this and also have it somewhere I can reference.

The case I have is for a private Insurance payer.

The provider is doing a TKA revision due to infection. While in the knee he also does a capsulotomy (bundled per AAOS) and excision of a soft tissue mass in the medial gutter of the knee.

"Posterior capsulotomy was performed to allow access for debridment of infected tissue in the posterior knee. The posterior capsule was debrided. A soft tissue mass measuring greater than 5cm was located in the medial gutter resulting in the need for additional dissection to perform excision of the soft tissue mass acheiing clean margins."

Because it is private, I am having a hard time determining if I should use the 27339-59 along with 27487 & 20704?

(The provider did revise the Tibial & Femoral components for the use of 27487 and also did manual preparation and insertion of stimulan beads (with antibiotics) so I will also be reporting 20704.)

Any help would be appreciated. Thanks!

 

[NRaizman]

Can you send whole report?
This seems -very- fishy.
Debriding an infection is not coded using a mass excision code.
If the knee is totally infected, one usually does not put a new prosthesis in, just an antibiotic spacer.

 

[amyjph]

Yes, would need whole op report redacted. This is odd. What was the "soft tissue mass"? Was it sent as a specimen? Synovitis, lipoma, etc?
Was this a one stage TKA revision (in and out same operative session) even though it was infected? Or, was the provider inserting a temporary prosthesis with the intent of going back in once the infection cleared and placing final components? 27487 is questionable in this case with the limited info above.