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

  1. #1
    Default Exchange of polyethylene liner, knee - The physician's report reads
    Medical Coding Books
    Does anyone know the CPT code for the exchange of a polyethylene liner of the knee?
    The physician's report reads "Utilizing approximately 3000 mL of sterile normal saline with bacitracin, we started liberal irrigation procedure. Following that, we removed the polyethylene liner and irrigated more fluid through the knee. A new polyethylene liner was inserted".

    Thanks for your help!!

  2. #2
    I do believe that you would use the revision code and use a 52 modifier!
    Tina Wosmek CPC, COSC

  3. #3
    There is a Pink Sheets article that directly addresses this I believe...

    I believe this is 27486/52 if the exchange goes off without a hitch. If there is a great amount of work or skill involved - difficulty removing, lodged under one of the components, etc. you can use 27486 without modifier 52...but I think that'd be comparable to justifying a modifier 22 in terms of documentation.

    If it was an easy out-easy in, I'd use 27486/52.

    Kara Hawes, CPC

  4. Default
    The Coder's Desk Reference states that revision codes 27486/87 apply to the femoral and tibial components only. I use the unlisted (27599) myself.
    Bruce Crandall, CPC
    North Carolina Specialty Hospital
    Durham, NC

  5. #5

    Here is the article stating to use 27486
    Tina Wosmek CPC, COSC

  6. Default Polyethylene Exchange
    Hi Tina,

    I can't get into that article but would love to read it. I have a case right now where surgeon exchanges the polyethylene insert and I'd like to know if I should bill the 27486 -52..... Thanks, Kathy G.

  7. #7
    Here is the article. I cut and pasted it. Hope it helps

    Removing poly liner in arthroplasty – complex or simple? Tips on deciding whether or not to use -52

    Your orthopedic surgeon schedules a patient for a revision of the tibial component of a right knee total arthroplasty, but instead of revising the entire component, he just needs to replace the polyethylene liner.

    You should bill this procedure using 27486 (revision of total knee arthroplasty, with or without allograft; one component), potentially adding modifier -52 (reduced services), says Robert Haralson, MD, the American Academy of Orthopedic Surgeons (AAOS) coding committee chair. This is correct because you are revising just one component and depending on the work involved in removing the poly liner from the tibial component you may need to append modifier -52 to indicate that the full description of the given code was not performed.

    Hold on, though. Don't automatically append modifier -52. There are times when the removal of the liner is more complex than simply popping it out and replacing it with a new one. Often, the doctor will find that the poly liner has become lodged under the lip of the metal component. Such an instance will require the surgeon to use greater skills and more work. This sort of scenario could thus possibly support reporting of the code without a modifier -52.

    Code 27486 has 35.84 relative value units (RVUs), which Medicare reimburses at $1,338.17 (Medicare facility rate, unadjusted for geographic locality). In this procedure, the orthopedist is revising one component – normally consisting of removing the poly liner, removing a prosthetic and replacing it with a new prothesis. When you're strictly replacing the poly liner, the -52 modifier tells the carrier you are not providing the full service as defined by the code descriptor and that payment should be adjusted.

    Note: When it is time to submit the claim form, do so with the full amount of the procedure listed, not a discounted amount. “For most payers, I'd recommend submitting the full fee and letting them take their standard percentage cut…” says Jo Ann Steigerwald , RHIT, ACS-GI, ACS-OH, Medical Business Specialists, Baraboo, Wisc.
    Tina Wosmek CPC, COSC

  8. Default
    This has always been my understanding that you always code the 27486 with 52 modifier when the surgeon replaces the polyethelene liner. Just today my surgeon said he read in one of his magazines if the intent is just to to do arthrotomy and clean out infection or hematoma you do not charge this revison code?? He did replace the liner on this one.
    Any comments or suggestions or recent articles is appreciated.

  9. #9
    Default confusion
    I have also read this new article where an arthrotomy is recommended based on the explantation and exchange of the polyliner is inclusive to debride the joint space. I am more confused than ever since the article is a contradiction to a previous article that company provided with guidance to use 27486-52 for the polyliner/revision.
    I now have two reliable coding sources with conflicting coding recommendations.

    any advise is recommended. tia

  10. #10
    CPT ?Assistant, December 2013, Volume 23, Issue 13, Page 16

    Question: A patient who is 10 years post surgery for a total knee arthroplasty undergoes surgery due to chronic knee pain. At the time of the surgery, the surgeon discovers polyethylene wear. The tibial polyethylene is revised, but the existing tibial tray is retained. Is this procedure reported with code 27486 , Revision of total knee arthroplasty, with or without allograft; 1 component, or should modifier 52, Reduced Services, be appended to code 27486 to indicate that the procedure was reduced because only the tibial polyethylene was revised?

    Answer: Because only the tibial polyethylene was revised, it would be appropriate to report code 27486 with modifier 52 appended to indicate the procedure was reduced. It may be necessary to include a copy of the operative report with the claim submission when using modifier 52.
    Carrie Ulintz

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