UNI Knee Revised to Total Knee

[Frosty]

We have a patient who had a unicompartmental knee arthroplasty. The DJD progressed to the other compartment & we had to take out the UNI knee and convert to a total knee. How to code? Any suggestions would be appreciated.

 

[margiev6]

Reference: AAOS Bulletin, October 2003: http://www2.aaos.org/aaos/archives/bulletin/oct03/code.htm

"Question:

A patient had a unicompartmental knee arthroplasty using code 27446. One year later, the patient had a revision of the hemiarthroplasty to a full arthroplasty. What codes would best represent this removal of the old compartment and then placement of a new total knee arthroplasty component?

Answer:

Normally, this would be coded 27487. The revision code includes the removal of the old prosthesis. However, depending upon documentation and the situation, this could also be coded 27447 and 27488 -51.

Note: This is not a revision of a total knee replacement. Except for removal of a partial tibial tray and femoral metal runner, the procedure is the same work as a primary total knee."

 

[KMCFADYEN]

27487 52

By Connie L. Zeller, CPC
September 05, 2013
Partial knee replacement surgery is becoming a common treatment option knees damaged by injury or disease such as osteoarthritis because the surgery is less invasive with less postoperative pain and better range of motion than total knee arthroplasty. However, there is a possibility that a patient will need a revision of a Unicompartmental Knee Arthroplasty (UKA) to a Total Knee Arthroplasty (TKA).

CPT code 27487, Revision of total knee arthroplasty, with or without allograft; femoral and entire tibial component, should be billed with modifier 52 for a reduced service. Revision of a Unicompartmental Knee Arthroplasty is the reduced service of a Total Knee Arthroplasty, there is not a CPT code for UKA revision. Also, if prosthesis is removed, use code 27488, Removal of prosthesis, including total knee prosthesis, methylmethacrylate with or without insertion of spacer, knee. Code 27488 should not be reported with code 27487 if a new prosthesis is implanted.

 

[Karen78]

I have a physician that has done what he calls a revision total knee 27487 but insurance is denying...they said there is another code when converting a unicompartmental to total. when I asked my physician to clarify his documentation he swears he revised the femoral and tibial components. however, he resurfaced the patellar which was not previously done. would you consider this a total with removal of previous prosthesis??? why or why not?

 

[clark.amy86]

I have a physician that has done what he calls a revision total knee 27487 but insurance is denying...they said there is another code when converting a unicompartmental to total. when I asked my physician to clarify his documentation he swears he revised the femoral and tibial components. however, he resurfaced the patellar which was not previously done. would you consider this a total with removal of previous prosthesis??? why or why not?

AAOS recommends 27447.22 for a conversion of a uni to total knee, but I bill 27487.52 with documentation and do not have an issue with getting Medicare to pay.

I am assuming you are dealing with a different payer here, so maybe the AAOS guideline would be better suited in this situation.