KStaten

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Hello, Everyone! :giggle:

I have noticed a few denials for the CPT code 27487 (Revision of total knee arthroplasty, with or without allograft; femoral and entire tibial component) when linked to T84.84XA (Pain due to internal orthopedic prosthetic devices, implants and grafts) and the corresponding Z-code, Z96.651 or Z96.52 (Presence of right/left artificial knee joint).

In some cases, the patient does not have component loosening or wear, nor injuries, such as fractures; they simply have pain and/or leg discrepancies the doctor has determined to be caused my the implants. Is this diagnosis code insufficient or am I doing missing something? I appreciate and value your input!

Thank You in advance!
Kim
 
T84.012ABroken internal right knee prosthesis, initial encounter
T84.012DBroken internal right knee prosthesis, subsequent encounter
T84.012SBroken internal right knee prosthesis, sequela
T84.013ABroken internal left knee prosthesis, initial encounter
T84.013DBroken internal left knee prosthesis, subsequent encounter
T84.013SBroken internal left knee prosthesis, sequela
T84.022AInstability of internal right knee prosthesis, initial encounter
T84.022DInstability of internal right knee prosthesis, subsequent encounter
T84.022SInstability of internal right knee prosthesis, sequela
T84.023AInstability of internal left knee prosthesis, initial encounter
T84.023DInstability of internal left knee prosthesis, subsequent encounter
T84.023SInstability of internal left knee prosthesis, sequela
T84.032AMechanical loosening of internal right knee prosthetic joint, initial encounter
T84.032DMechanical loosening of internal right knee prosthetic joint, subsequent encounter
T84.032SMechanical loosening of internal right knee prosthetic joint, sequela
T84.033AMechanical loosening of internal left knee prosthetic joint, initial encounter
T84.033DMechanical loosening of internal left knee prosthetic joint, subsequent encounter
T84.033SMechanical loosening of internal left knee prosthetic joint, sequela
T84.052APeriprosthetic osteolysis of internal prosthetic right knee joint, initial encounter
T84.052DPeriprosthetic osteolysis of internal prosthetic right knee joint, subsequent encounter
T84.052SPeriprosthetic osteolysis of internal prosthetic right knee joint, sequela
T84.053APeriprosthetic osteolysis of internal prosthetic left knee joint, initial encounter
T84.053DPeriprosthetic osteolysis of internal prosthetic left knee joint, subsequent encounter
T84.053SPeriprosthetic osteolysis of internal prosthetic left knee joint, sequela
T84.062AWear of articular bearing surface of internal prosthetic right knee joint, initial encounter
T84.062DWear of articular bearing surface of internal prosthetic right knee joint, subsequent encounter
T84.062SWear of articular bearing surface of internal prosthetic right knee joint, sequela
T84.063AWear of articular bearing surface of internal prosthetic left knee joint, initial encounter
T84.063DWear of articular bearing surface of internal prosthetic left knee joint, subsequent encounter
T84.063SWear of articular bearing surface of internal prosthetic left knee joint, sequela
T84.092AOther mechanical complication of internal right knee prosthesis, initial encounter
T84.092DOther mechanical complication of internal right knee prosthesis, subsequent encounter
T84.092SOther mechanical complication of internal right knee prosthesis, sequela
T84.093AOther mechanical complication of internal left knee prosthesis, initial encounter
T84.093DOther mechanical complication of internal left knee prosthesis, subsequent encounter
T84.093SOther mechanical complication of internal left knee prosthesis, sequela
T84.53XAInfection and inflammatory reaction due to internal right knee prosthesis, initial encounter
T84.53XDInfection and inflammatory reaction due to internal right knee prosthesis, subsequent encounter
T84.53XSInfection and inflammatory reaction due to internal right knee prosthesis, sequela
T84.54XAInfection and inflammatory reaction due to internal left knee prosthesis, initial encounter
T84.54XDInfection and inflammatory reaction due to internal left knee prosthesis, subsequent encounter
T84.54XSInfection and inflammatory reaction due to internal left knee prosthesis, sequela
*ICD-10-CM diagnosis codes Z96.651, Z96.652 and Z96.653 should not be used as a primary diagnosis code when billing for a revision of a total knee replacement. They should be used in conjunction with one of the following diagnoses: M97.11XA-M97.12XS, T84.012A-T84.013S, T84.022A-T84.023S, T84.032A-T84.033S, T84.052A-T84.053S, T84.062A-T84.063S, T84.092A-T84.093S, T84.53XA-T84.54XS.

This is part of the LCD list for 27486/27487 from Medicare and T84.84XA is not a covered diagnosis. I have encountered the same denial as you in the past and if the documentation in the patient chart was sufficient, I would update the diagnosis to a better suited one from the LCD list. I am typically more inclined to use T84.092-3A if there is mention of a potential complication with the prosthesis itself, but no detail on what that may be and pain being the only definitive diagnosis. As always, go with your gut and if you are still unsure query the physician.
 
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