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Septic Revision TKA

Messages
234
Location
Reno, Nevada
Best answers
0
HELP! What is the correct way to code this procedure?


Would this be coded as:
27488
11981-51-?

or

27487
11981-51-?

" The patient was brought to the operating room after general anesthetic was induced. The left knee was prepped and draped in sterile orthopedic fashion. The previous incision was used, and incision ws carried out throughthe skin an subcutaneous tissue. A [_} parapatellar arthrotomy was performed with quadriceps snip proximally. The patient was noted to have evidence of sepsis. Cultures were taken. Synovectomy was performed, and after undercutting the surfaces of the implants to remove bone cement with oscillating reciprocal saw, the distal femoral implant was removed with a bone tamp and a mallet exposing the cone and stem. Teh tibia was then undermined with thte oscillating reciprocal saw, and the tibial implant was removed with the bone tamp.

Unfortunately, the stem and come came out at the same time. The distal femoral conde was loosened by using the reciprocal saw, flexible osteotomies 360 degrees around the stem, and it was removed with vice grips and a slap hammer. The remaing bone quality was satisfactomry.

After the canals were debrided with curettage, and soft tissue was removed, final irrigation was carried out for batches of Tobramycin impregnated methyl methacrylate with 6 grams additional Vancomycin were inserted, and stable methyl methacrylate prosthesis was inserted. The stability was quite excellent after hardening of the prosthesis. The patella was removed. The fascial later was closed with interrupted #2 nylon mattress sutures. A sterile compressive dressing was applied. The patient was returned to the recovery room in stable postoperative condition. "
 

OCD_coder

True Blue
Messages
937
Location
Nashville AAPC Chapter
Best answers
0
A septic TKA is usually a 2 stage procedure. I can't verify that the tibial and femoral component were replaced, the "prosthesis" placed is a temporary plastic spacer so that the bones don't rub. So you are correct with your first code combination 27488. They need to get the sepsis under control before they replace the components.

They will go back in and remove the "liner" and place the femoral and tibial component, that will be a 27447-58 if done within the global period of the 27488 removal of prosthesis done here.

Here is a very good article about staged TKA's by the AAOS.
http://www.aaos.org/news/bulletin/sep07/managing1.asp
 
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