Wiki 27487 vs 27488

[lisammy]

I have an orthopedic surgeon who is questioning our use of 27487 when he places an articulating spacer. He stated he found a article that stated we should be using it should be coded as 27487 because it is an articulating spacer vs a static spacer. Besides the one article he provided us, we can not find any other collaborating information. Any help either way would be much appreciated.
Our coder response:
CPT code 27488 is for removal of a prosthesis, including total knee prosthesis, with or without insertion of spacer, knee
27487 is a revision of a total knee arthroplasty, femoral and entire tibal components

In order to bill a revision it has to be removed and re placed in the same visit.
So if you were removal the total knee prosthesis and replaced a spacer the correct code would be…. 27488.

His argument:
Please take a look at the link I sent, this is a new change since last 1-2 years ago.

The spacer that I'm using is not a static spacer, it is actually an articulating spacer which is working as a temporary knee prosthesis until they get the final surgery. With this articulating knee spacer they are able to ambulate and move around. So that is the difference and that's why it is considered as a revision surgery rather than a removal of hardware and placement of static cement spacer.

http://www.margievaught.com/index.cfm?fuseaction=event&mode=1&eventID=175#:~:text=Infected%20left%20TKA%20were%20they%20remove%20the%20prosthesis%20and%20place%20an%20articulating%20spacer.%20The%20billing%20would%20be%2027487

 

[amyjph]

Your first sentence/paragraph is a little confusing. Is there a typo of the CPT codes? Is he questioning coding 27488?

Did you check CPT Assistant? I believe CPT Assistant stated at one point the spacer type (articulating vs. static) does not matter. The last I knew (2020) this was the stance. I don't have CPT Assistant right now to check. This will be your definitive answer. I understand what he is saying that they could "technically" keep that articulating spacer and walk around on it & possibly never replace it, but if the intent is to take it out later for a definitive, that's what matters. At least, this is my most recent understanding. So, this patient's progression of codes would have been: 27447 (TKA) whenever that was, 27488 (remove TKA, insert spacer for infection), 27447 (possible 22, remove spacer, implant new, final TKA after infection clears). Sometimes if it is really bad I have seen where they do another round of spacer or something happens and they never go back in but those are outliers.

What is the exact surgery being performed? Is it removal of TKA prosthesis for infection and implantation of spacer? Then, later plan to go back in once the infection clears, remove the temp. spacer & implant a final TKA? In your example above, "working as a temporary knee prosthesis until they get the final surgery." If that is the case it is 27488.

That link is a bit wonky. I would not agree with reporting 27487 twice in a row for this. 27487 is when they remove and replace with a final implant all in one surgical session. 27488 is for when they remove the prosthesis and put a spacer in. It does not matter what type of spacer if the intent is to take it out later for a final once the infection clears. We also can't use a "Because Margie Vaught said so in this wonky link" to justify coding.

Then you also have to consider the descriptions and rules for the drug delivery device codes, 2070_, however would also check CPT Assistant on that too. Generally, you can't report the drug delivery device with 27488.

 

[lisammy]

Thank you for your response. Yes i did mean 27488. We are stating it would be 27488 and he believes it should be 27447. I will see what i can find in the CPT assistant.

 

[amyjph]

Thank you for your response. Yes i did mean 27488. We are stating it would be 27488 and he believes it should be 27447. I will see what i can find in the CPT assistant.

I agree with you, unless there is some brand new CPT assistant guidance, it is 27488. If it is removal of TKA prosthesis for infection and implantation of spacer with plan to remove and put in a new, final TKA later.