Wiki AETNA DENYING REMOVAL OF NON-BIODEGRADABLE IMPLANT

Vmyers831

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We have a pt that had a total knee, then developed an infection outside of post op period. they removed the prosthesis, inserted the non-biodegradable drug delivery implant, then after post op period for that surgery, they removed the device and inserted a new prosthesis. Aetna is denying the drug implant. Is anyone else familiar with the billing of these codes and may have some billing incite for me? We have tried billing with a modifier as well, no luck. We billed 27442, 22, LT and 11982, 22, LT. Side note: they denying the insertion of the implant as well.
 
With this situation why is 27442 being billed? Not related. The code to remove the infected knee prosthesis and insert a spacer would be 27488.

For me the use of modifier -22 twice is probably a red flag.
 
With this situation why is 27442 being billed? Not related. The code to remove the infected knee prosthesis and insert a spacer would be 27488.

For me the use of modifier -22 twice is probably a red flag.
27442 was a keying mistake on this forum. We billed the 27447. This procedure was to remove the spacer and insert the prosthesis again.
 
27442 was a keying mistake on this forum. We billed the 27447. This procedure was to remove the spacer and insert the prosthesis again.
Yes, I was not 100% sure about the -22 on both lines either. I work denied claims, so I am trying to see if I am able to submit a cc to have these services paid (The implantation and removal of the non-biodegradable drug implant).
 
Removing the infected components have a 90 day global. The antibiotic spacers are usually only kept in for about six weeks. My guess is that you are billing the removal of the spacer and implantation of the new knee components within the global period of removing the components. I would really double check the use of the modifier -22 as well and make sure that the documentation supports using them on both procedures. My guess is that they are not supported. I think the reason for the denial is that you need a modifier since its almost certain removing the spacer and putting in the implants are within the global period.
 
No, the spacers were removed outside of the global period. TKA was performed 10/2018. TKA became infected 12/2018. Removed hardware and inserted spacer 06/2019 and did not remove spacer and reinsert new prosthesis until 11/2019.
 
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