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Thread: Exchange of polyethylene liner, knee - The physician's report reads

  1. #11

    Question Cpc,cpma

    AAPC: Back to School
    My question it
    is biliable 27301AS as 58 with 27486AS

  2. #12
    Join Date
    Apr 2007


    It depends on the reason for the polyethylene exchange from my understanding. You would use the arthrotomy code 27310 if the surgeon is going in to clean out the joint due to infection.Tthe polyliner was only removed to gain access to the back of the knee. If the exchange is due to a mechanical problem then you would use the revision code 27486 with Mod 52. I was told this at one of the sessions at HealthCon

  3. #13

    Default exchange polyethylene liner AND insert patellar prosthesis

    Could I bill with 27486 (no modifier 52) for the procedure, or should I bill 27486,52 AND 27438,51?

    A large amount of synovial fluid was evacuated from the joint space. The femoral component was exposed, but clearly was not loose. The patella was mobilized and she was noted to have superior deformity and degenerative change of the undersurface of the patella. It was therefore decided at that point to resurface the patella. The lateral platau was exposed and the patella everted. A patella clamp was placed and an oscillating saw used to retract the undersurface of the patella. Once a flat cut was obtained, the Zimmer Natural-Knee components were used. The fixation peg holes were drilled with a step drill and a trial size #17mm thickness patellar component was inserted and appeared to fit very nicely. This was then removed. Attention was focused back down to the polyethylene exchange. The knee flexed and the patella everted. The tibial component readily exposed. Curved osteotome was used to remove the polyethylene spacer, which was clearly eroded more laterally. Once this was removed, the baseplate was noted to be completely intact without any loosening. Trial components were used to replace the spacer, and ultimately chosen for implantation was a 16mm thickness polyethylene insert. The joint space was copiously irrigated and a size 0 Natural-Knee II Durasul Ultracongruent tibial insert was impacted onto the baseplate without difficulty. One pack of polymethylmethacrylate cement was mixed. Pulse lavage was used on the patella and the cement was applied to the size #1 symmetrical round patella. All polyethylene component was 7mm thick. The patellar component was then placed into the previously drilled peg holes and the clamp was used. Excess cement was removed and the cement was allowed to set completely.

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