Exchange of polyethylene liner, knee - The physician's report reads

trvlingal

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Does anyone know the CPT code for the exchange of a polyethylene liner of the knee?
The physician's report reads "Utilizing approximately 3000 mL of sterile normal saline with bacitracin, we started liberal irrigation procedure. Following that, we removed the polyethylene liner and irrigated more fluid through the knee. A new polyethylene liner was inserted".

Thanks for your help!!
 
There is a Pink Sheets article that directly addresses this I believe...

I believe this is 27486/52 if the exchange goes off without a hitch. If there is a great amount of work or skill involved - difficulty removing, lodged under one of the components, etc. you can use 27486 without modifier 52...but I think that'd be comparable to justifying a modifier 22 in terms of documentation.

If it was an easy out-easy in, I'd use 27486/52.

Kara Hawes, CPC
 
The Coder's Desk Reference states that revision codes 27486/87 apply to the femoral and tibial components only. I use the unlisted (27599) myself.
 
Polyethylene Exchange

Hi Tina,

I can't get into that article but would love to read it. I have a case right now where surgeon exchanges the polyethylene insert and I'd like to know if I should bill the 27486 -52..... Thanks, Kathy G.
 
Here is the article. I cut and pasted it. Hope it helps

Removing poly liner in arthroplasty – complex or simple? Tips on deciding whether or not to use -52

Your orthopedic surgeon schedules a patient for a revision of the tibial component of a right knee total arthroplasty, but instead of revising the entire component, he just needs to replace the polyethylene liner.

You should bill this procedure using 27486 (revision of total knee arthroplasty, with or without allograft; one component), potentially adding modifier -52 (reduced services), says Robert Haralson, MD, the American Academy of Orthopedic Surgeons (AAOS) coding committee chair. This is correct because you are revising just one component and depending on the work involved in removing the poly liner from the tibial component you may need to append modifier -52 to indicate that the full description of the given code was not performed.

Hold on, though. Don't automatically append modifier -52. There are times when the removal of the liner is more complex than simply popping it out and replacing it with a new one. Often, the doctor will find that the poly liner has become lodged under the lip of the metal component. Such an instance will require the surgeon to use greater skills and more work. This sort of scenario could thus possibly support reporting of the code without a modifier -52.

Code 27486 has 35.84 relative value units (RVUs), which Medicare reimburses at $1,338.17 (Medicare facility rate, unadjusted for geographic locality). In this procedure, the orthopedist is revising one component – normally consisting of removing the poly liner, removing a prosthetic and replacing it with a new prothesis. When you're strictly replacing the poly liner, the -52 modifier tells the carrier you are not providing the full service as defined by the code descriptor and that payment should be adjusted.

Note: When it is time to submit the claim form, do so with the full amount of the procedure listed, not a discounted amount. “For most payers, I'd recommend submitting the full fee and letting them take their standard percentage cut…” says Jo Ann Steigerwald , RHIT, ACS-GI, ACS-OH, Medical Business Specialists, Baraboo, Wisc.
 
This has always been my understanding that you always code the 27486 with 52 modifier when the surgeon replaces the polyethelene liner. Just today my surgeon said he read in one of his magazines if the intent is just to to do arthrotomy and clean out infection or hematoma you do not charge this revison code?? He did replace the liner on this one.
Any comments or suggestions or recent articles is appreciated.
 
confusion

I have also read this new article where an arthrotomy is recommended based on the explantation and exchange of the polyliner is inclusive to debride the joint space. I am more confused than ever since the article is a contradiction to a previous article that company provided with guidance to use 27486-52 for the polyliner/revision.
I now have two reliable coding sources with conflicting coding recommendations.

any advise is recommended. tia
 
CPT ?Assistant, December 2013, Volume 23, Issue 13, Page 16

Question: A patient who is 10 years post surgery for a total knee arthroplasty undergoes surgery due to chronic knee pain. At the time of the surgery, the surgeon discovers polyethylene wear. The tibial polyethylene is revised, but the existing tibial tray is retained. Is this procedure reported with code 27486 , Revision of total knee arthroplasty, with or without allograft; 1 component, or should modifier 52, Reduced Services, be appended to code 27486 to indicate that the procedure was reduced because only the tibial polyethylene was revised?

Answer: Because only the tibial polyethylene was revised, it would be appropriate to report code 27486 with modifier 52 appended to indicate the procedure was reduced. It may be necessary to include a copy of the operative report with the claim submission when using modifier 52.
 
It depends on the reason for the polyethylene exchange from my understanding. You would use the arthrotomy code 27310 if the surgeon is going in to clean out the joint due to infection.Tthe polyliner was only removed to gain access to the back of the knee. If the exchange is due to a mechanical problem then you would use the revision code 27486 with Mod 52. I was told this at one of the sessions at HealthCon
 
exchange polyethylene liner AND insert patellar prosthesis

Could I bill with 27486 (no modifier 52) for the procedure, or should I bill 27486,52 AND 27438,51?

A large amount of synovial fluid was evacuated from the joint space. The femoral component was exposed, but clearly was not loose. The patella was mobilized and she was noted to have superior deformity and degenerative change of the undersurface of the patella. It was therefore decided at that point to resurface the patella. The lateral platau was exposed and the patella everted. A patella clamp was placed and an oscillating saw used to retract the undersurface of the patella. Once a flat cut was obtained, the Zimmer Natural-Knee components were used. The fixation peg holes were drilled with a step drill and a trial size #17mm thickness patellar component was inserted and appeared to fit very nicely. This was then removed. Attention was focused back down to the polyethylene exchange. The knee flexed and the patella everted. The tibial component readily exposed. Curved osteotome was used to remove the polyethylene spacer, which was clearly eroded more laterally. Once this was removed, the baseplate was noted to be completely intact without any loosening. Trial components were used to replace the spacer, and ultimately chosen for implantation was a 16mm thickness polyethylene insert. The joint space was copiously irrigated and a size 0 Natural-Knee II Durasul Ultracongruent tibial insert was impacted onto the baseplate without difficulty. One pack of polymethylmethacrylate cement was mixed. Pulse lavage was used on the patella and the cement was applied to the size #1 symmetrical round patella. All polyethylene component was 7mm thick. The patellar component was then placed into the previously drilled peg holes and the clamp was used. Excess cement was removed and the cement was allowed to set completely.
 
Can I revive this last post? I have two of these where he exchanged the tibia liner 27486-52 and also had to do 27438 because of significant wear on the native patella. Would this still be only 27486-52 because of the NCCI edits?
 
The code description for 27486 says in part, "...In 27486, one of the femoral or tibial components or the polyethylene liner is removed as determined by the physician." So why would you append 52 when the liner is replaced?
 
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