Wiki CPT REMOVAL TKR COMPONENTS W/PLACEMENT OF TEMPORARY COMPONENTS

[terribo]

Scenario-Patient has TKR performed several years ago that is now infected. The components are removed and TEMPORARY components (NOT SPACER-OR IS IT THE SAME THING ?) are placed w/antibacterial cement. What is the CPT code for this scenario? We used 27487 w/primary DX T84.54XA for infection of internal prosthesis and secondary DX Z96.652. Should that scenario been billed as 27488?

The patient returns for removal of the temporary components and final implants are placed. What is the CPT code? DX?

I am somewhat confused due to other info that stats patient has antibiotic implant type of prosthesis and when new components are placed, we are to bill 27447/58/22? Then there is the problem of the DX for that scenario.

I think 27488 should have been billed w/temporary components and 27487 should be billed w/final components, but I may be overthinking and now I am confusing myself. Please help.

 

[amyjph]

You're not alone in your confusion. Revision arthroplasty and staged arthroplasty are often coded incorrectly and stump folks.

If the patient has a TKA in place, it becomes infected, surgeon removes it and places abx components to remove in another stage later once the infection clears (whether called temporary or spacer, or whatever), you code 27488. When they bring the patient back later to remove the abx spacer and implant the new (final) TKA, you code 27447 with a possible 22 modifier depending on the documentation. Coding 27487 when they remove a TKA and implant a spacer is not correct. 27487 is only for single stage (same operative session) removal and replacement of the whole TKA all at once. 27487 for removal of the abx spacer and implanting the new TKA is not it either.
The diagnosis is not going to be the exact same for all, you have to do it by the documentation. Usually it would be the T84 area for the infection of the prosthesis but there can be exceptions. When you bring them back for stage two it might turn into Z47.33 with the infection and S code to show that was the reason originally but now the infection has cleared. It really depends on the note.

Modifier 58 depends on if they are still in the global of the prior case or not. If they are still in the global when they remove the abx spacer and implant the new TKA you use 58 to show it was planned/staged to the prior case.

There are some exceptions and outliers to this. I have seen where a patient has a TKA infection and other issues, they remove the TKA, and put a spacer in but it's actually meant to stay in there forever which is a weird scenario. In that case we did something different because it was meant to be the "final" implant even though it was a special articulating spacer type implant.

This arthroplasty webinar might really help your office: https://karenzupko.com/bundle-1-the...lasty-from-a-to-z-fracture-care-step-by-step/
"This course will review the important changes for Joint Arthroplasty (Hip, Knee, and Shoulder) and drug delivery device updates, revision arthroplasty vs. replacement coding guidelines and hands-on case exercises for hip, knee, and shoulder replacements."
It's been a minute since I was on the provider side so I am not sure what these updates are/were for 2023. There are a # of CPT Assistant articles on arthrplasty you would want to check too. It is possible there could be new info I am not up to date on for 2023.

 

[terribo]

You're not alone in your confusion. Revision arthroplasty and staged arthroplasty are often coded incorrectly and stump folks.

If the patient has a TKA in place, it becomes infected, surgeon removes it and places abx components to remove in another stage later once the infection clears (whether called temporary or spacer, or whatever), you code 27488. When they bring the patient back later to remove the abx spacer and implant the new (final) TKA, you code 27447 with a possible 22 modifier depending on the documentation. Coding 27487 when they remove a TKA and implant a spacer is not correct. 27487 is only for single stage (same operative session) removal and replacement of the whole TKA all at once. 27487 for removal of the abx spacer and implanting the new TKA is not it either.
The diagnosis is not going to be the exact same for all, you have to do it by the documentation. Usually it would be the T84 area for the infection of the prosthesis but there can be exceptions. When you bring them back for stage two it might turn into Z47.33 with the infection and S code to show that was the reason originally but now the infection has cleared. It really depends on the note.

Modifier 58 depends on if they are still in the global of the prior case or not. If they are still in the global when they remove the abx spacer and implant the new TKA you use 58 to show it was planned/staged to the prior case.

There are some exceptions and outliers to this. I have seen where a patient has a TKA infection and other issues, they remove the TKA, and put a spacer in but it's actually meant to stay in there forever which is a weird scenario. In that case we did something different because it was meant to be the "final" implant even though it was a special articulating spacer type implant.

This arthroplasty webinar might really help your office: https://karenzupko.com/bundle-1-the...lasty-from-a-to-z-fracture-care-step-by-step/
"This course will review the important changes for Joint Arthroplasty (Hip, Knee, and Shoulder) and drug delivery device updates, revision arthroplasty vs. replacement coding guidelines and hands-on case exercises for hip, knee, and shoulder replacements."
It's been a minute since I was on the provider side so I am not sure what these updates are/were for 2023. There are a # of CPT Assistant articles on arthrplasty you would want to check too. It is possible there could be new info I am not up to date on for 2023.

Thank you so much for your response. I was thinking that the code should be 27488 for the temporary component. I will definitely check out the KZA info. I have been doing this for a long time...I should have this down but every now and then somebody says something that makes me question what I think I know. Thanks again!

 

[amyjph]

Thank you so much for your response. I was thinking that the code should be 27488 for the temporary component. I will definitely check out the KZA info. I have been doing this for a long time...I should have this down but every now and then somebody says something that makes me question what I think I know. Thanks again!

You're welcome. It is confusing for sure even after doing it a long time. You start wondering if it's you lol.