Polythylene insertion

klbecker

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One of my doctors had performed a total knee replacement on a patient 3 weeks ago. The patient comes to the ER with joint infection. He takes the patient to the OR performs an arthrotomy with removal of only the polyethylene. He inserts an antibiotic spacer and wound vac for a week then takes the patient back to wash out the knee joint again and replace the polyethylene. I'm stumped as to what CPT code to use for the replacement of only the polyethylene. Would I use 27486 w/ 52? My only draw back with that is he's not removing and replacing it in the same visit. Or would I use an unlisted code?

Any help is GREATLY appreciated.
Thanks
Kristy
 

emmyjean

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I'm leaning towards 27446-52(and modif 58 since it'll be staged/related during post op) and also 11982. The doc took the poly out and inserted a spacer. This wouldn't be a revision because there's no poly in there at present time to revise (just a spacer). I know when a full TKA is removed and then inserted again weeks down the road, we bill 27447-22. I would think the same would apply with partial TKA removed except using a -52 rather than -22 since this is just for the poly. How did you bill the removal of the poly with insertion of a spacer? 27488-52 and 11981?



I'm curious to read others' input...
 

monica03

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I'm leaning towards 27446-52(and modif 58 since it'll be staged/related during post op) and also 11982. The doc took the poly out and inserted a spacer. This wouldn't be a revision because there's no poly in there at present time to revise (just a spacer). I know when a full TKA is removed and then inserted again weeks down the road, we bill 27447-22. I would think the same would apply with partial TKA removed except using a -52 rather than -22 since this is just for the poly. How did you bill the removal of the poly with insertion of a spacer? 27488-52 and 11981?



I'm curious to read others' input...


There used to be a post on the AAOS website that said to use 27486,52 for a poly exchange. You can't get to it now because it says you have to sign in. There is also a pink sheet out there somewhere that says the same thing.
 

emmyjean

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I do have a print out from AAOS regarding 2-stage TKA procedures. In this print out it states to use 27447-22 after the spacer is removed. In this instance, I would feel 27446 would be best based on this example for a poly insertion after a spacer. To each his own though :)


I'm not sure the page will come up, but at the bottom of my print out here is the link:
http://www.aaos.org/news/bulletin/sep07/managing1.asp
 

amyjph

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There used to be a post on the AAOS website that said to use 27486,52 for a poly exchange. You can't get to it now because it says you have to sign in. There is also a pink sheet out there somewhere that says the same thing.

You can still get to it, just have to register on the AAOS website, you can do so as a coder. Just a tip.
Look it up on Karen Zupko as well, should be there.
 

monica03

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You can still get to it, just have to register on the AAOS website, you can do so as a coder. Just a tip.
Look it up on Karen Zupko as well, should be there.

Thanks I didn't know that I could sign up. I figured you had to be a doctor and it would cost to sign up. I still can't find the article that I am looking for but I did find an article on the AAPC website https://www.aapc.com/blog/32895-coding-that-brings-you-to-your-knees/ that does say
If only the liner was removed and replaced, report 27486 with modifier 52 Reduced services.
 

emmyjean

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In the same surgical session, yes 27486-52 should be used. If they take out the poly, put in a spacer for a week, then go back in and put in a new poly, how can you still charge 27486?? If this was correct, how would you go back and code insertion and removal of the spacer?? If it's two separate surgical sessions (a week apart), you cannot code a revision if there's no poly in there to revise; there's only a spacer.
 

amyjph

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Good discussion! Maybe a possibility of 27488 (w or w/o 52) & 11981 for the first stage? Then when he goes back in maybe 27446-52 & 11982? Just ideas. I have never seen them do a poly exchange in two stages.
 

sxcoder1

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Good discussion! Maybe a possibility of 27488 (w or w/o 52) & 11981 for the first stage? Then when he goes back in maybe 27446-52 & 11982? Just ideas. I have never seen them do a poly exchange in two stages.

I agree with these codes and also agree that 27486 should not be used in a 2 stage procedure.
 

emmyjean

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Good discussion! Maybe a possibility of 27488 (w or w/o 52) & 11981 for the first stage? Then when he goes back in maybe 27446-52 & 11982? Just ideas. I have never seen them do a poly exchange in two stages.


This is exactly what I've been suggesting!
 
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