Total remove knee spacer insert total knee components

Mary Baierl

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What CPT is best when the surgeon takes out the spacer and replaces with new components, tibial, femoral and patellar? 27447 is from a knee never replaced before, so this does not describe what he is doing. 27487 is taking out all the total knee components and putting back in total knee componentns. That seems like too much work for what he is actually doing by removing the spacer. 27488 is the opposite procedure from what is being done? Should I code unlisted and compare to 27488??
 
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I have an article from the AAOS about this scenario...as my surgeons have done this before.

The first stage should be 27488 and 11981.

The second stage should be 27487-58 and 11982. AAOS also suggests that you can use a 22 modifier for this stage (27487) because the surgical field has been altered, and the procedure is more difficult.

Hope this helps, have a good day. :)
 

CULINTZ

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The article I see on AAOS website indicates that revision code 27487 describes total knee revision surgery with exchange to the definitive prosthesis being done in the same surgical session. It also indicates that if the same surgeon that inserted the spacer brings the patient back to the operating room to remove the spacer, and replaces it with the definitive knee prosthesis, this procedure would be reported using code 27447-58, 22—Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty) and 11982-58-51—Removal, non-biodegradable drug delivery implant.
 
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nyyankees

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What CPT is best when the surgeon takes out the spacer and replaces with new components, tibial, femoral and patellar? 27447 is from a knee never replaced before, so this does not describe what he is doing. 27487 is taking out all the total knee components and putting back in total knee componentns. That seems like too much work for what he is actually doing by removing the spacer. 27488 is the opposite procedure from what is being done? Should I code unlisted and compare to 27488??
27447-22 - make sure doc notes an altered surgical feild to collect the 22 modifier...
 

nyyankees

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What CPT is best when the surgeon takes out the spacer and replaces with new components, tibial, femoral and patellar? 27447 is from a knee never replaced before, so this does not describe what he is doing. 27487 is taking out all the total knee components and putting back in total knee componentns. That seems like too much work for what he is actually doing by removing the spacer. 27488 is the opposite procedure from what is being done? Should I code unlisted and compare to 27488??
It's a CONVERSION and not a Revision. Since there is no Total Knee Conversion you would use 27447.
 
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