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TKA-Help - Please help with

  1. #1
    Default TKA-Help - Please help with
    Medical Coding Books
    Please help with the coding of this procedure.
    The patient had significant tight patellofemoral joint after trial prosthesis were placed. This required a V-Y advancement iwth application of the Graphjacket to support the quad tendon, reinforce the quad tendon with much longer than more tedious more complicated than the usual total knee replacement.
    once the trials were placed, it was noted that the patella was very tight despite the normal resection lateral release and fraying of the tendon. A broad based V-Y advancement was necessary from the quadriceps tendon. This was repaired with a #2 ortho cord and then wrapped and secired with a Vitagel soaked Graphjacket. This was circumferentially secured after preoperative flexion was about 70 degrees and postoperatively, we got about 110 to 120 degrees without any significant tension on the repair. this will be protected in a brace locked at 90 degrees to prevent over stress to the graft. She will be toe-touch for partial weight bearing as well.
    Precedure: The patient was identified, brought into the operating room, and placed in supine position. Appropriate antibiotic was administered. The patient was placed under femoral nerve block and spinal anesthetic. A Foley catheter was placed.
    After formal prepping and draping of the left knee, the touriquet was inflated to 300 mmHg. incision was made from the superior pole of the patella and ttaken down distally to the tibial tubercle. Subcutaneous tissue was undermined and hemostasis was achieved using electrocautery. A standard medical parapatellar arthrotomy was performed and the patella was everted. The intramedullary canal of the femur was then opened, a 6-degree intramedullary alignment jig was placed and a distal cut was made. the medial collateral ligament was released. The lateral collateral ligament was released and the posterior cruciate ligament was removed as well as the medial and lateral meniscus. the external tibial alignment jig was placed and a cut was made 4 mm below the medical joint line, perpendicular to the ankle axis, recreating the posterior slip of the tibia.
    After this bone was removed, the extension gap was checked and matched at 14 mm. the sizing block was applied and measured to be 16 mm. An all-in-one block was applied and all cuts were made. Flexion and extension gaps were matched at 14. the patella was osteotomized and measured to be 28. A 3-prong patella was drilled. the tibia was brought forward and templated for 71. The I-beam broached the appropriate amount of rotation. The bone was then pulse lavaged. Palacos cement was mixed, the above mentioned components were placed, excess cement was removed, and the cement was allowed to harden. The tourniquet was then deflated and hemostasis was achieved with electrocautery; and once this was done, the tourniquet was reinflated. the 14-mm standard poly was then placed and clipped into position. Full range of motion was achieved, patellar tracking was excellent. No varus-valgus instability was seen.
    The wound was then copiously, irrigated and dried. previously obtained blood was spun down using a centrifugeapparatus; this created an autologous soft tissue graft made up of hematopoietic cells. This was injected into the joint and allowed to congeal. this allowed for coagulation. the wound was thenclosed over Hemovac drain with #14 Vicryl, 2-0 Vicryl and staples. Streile dressing were applied and the patient was transferred to the recovery room in stable condition.
    The procedure was billed with CPT codes: 27447-22-LT
    Claim paid CPT code 27447 and 11952 and denied the other procedures as inclusive.
    Please let me know what you think and as always Thank You for your help

  2. #2
    Any help with this would still be greatly appreciated. Thanks

  3. #3
    Hartford, CT
    I would agree with the way the insurance company paid except for code 11952. Modifier 22 indicates that the procedure was more diffcult than normal. 27422 is a component of the TKA and 29873 is an arthroscopic procedure, there is no indication that anything was done arthroscopically and open lateral release is bundled into the TKA. I also would not have billed 11952, the CPT description for this code is SUBCUTANEOUS injection of filling material. The hematopoietic cells are not considered a filling material and the note states that this was injected into the joint, not subcutaneous tissue.

    Others may have a different opinion on the coding, but I would have only coded 27447, 22, LT
    Last edited by dclark7; 01-11-2012 at 12:51 PM. Reason: spelling

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