Unicompartmental Knee to Total Knee

Need help!! Having a dispute between 27487-52 & 27447-22. Have a patient that had a medial unicompartmental knee arthroplasty done a few years ago. Now is having progression of arthrosis to the lateral & patellofemoral compartment. Dr. is removing the Oxford medial unicompartmental knee arthroplasty & converting to TKA. According to the AMA CPT assist from July 2013 27487-52 is a revision of someone that has already had a Total Knee Replacement. Dr. is inserting implants Depuy-Attune Size 4N femur, Size 3 tibia, Attune posterior stabilized polyethylene size 4/10 mm & attune medialized anatomic patella size 35mm. I found an article from AAOS October 2003 Bulletin Common coding questions & answers that says this normally would be coded 27487 the revision code includes the removal of old prosthesis, however depending upon documentation & the situation, this could also be coded 27447 & 27488-51. Goes on to include Note: This is not a revision of a TKR. Except for removal of a partial tibial tray & femoral metal runner, the procedure is the same work as a primary total knee. I know 27488 is a column 2 code so would only charge 27447. Am I misunderstanding these articles? To me this would be more work therefore I don't understand why we would use 27487-52. Margie or Ruby can you please help? Thanks in advance for anyone to help solve this problem.

Comments

  • edited May 2017
    In contacting the AMA recently regarding this issue as many surgeons are
    finding they are getting paid less for converting a Uni to a total, with the
    reporting per the AMA of the revision code with modifier 52, they stated
    that there would be some new information coming out regarding how to code
    and report these situations.
    Most surgeons are doing the 27447-22 at this time.

    Margie Scalley Vaught, CPC, COC, CPC-I, CCS-P, MCS-P, ACS-EM, ACS-OR
    Auditing, Coding, Documentation and Compliance Consulting
    Healthcare Consultant scalley123@aol.com
    cell 360-880-8304
    fax 413-674-7668_www.margievaught.com_ (http://www.margievaught.com/)
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  • edited May 2017
    Actually CPT Assistant says for a uni to total it is the revision with a 52. A revision of a total would not use a 52 modifier. Only spacer exchanges that are due to implant issues would use s 52.

    Ruby Woodward 
  • edited May 2017
    Margie,

    Do you recommend doing the 27447 -22 for a uni to a TKA? We have been following AMA rules, due to having a source document to prove why we do it. Suggestions?
  • edited May 2017
    AAOS has stated that it using the revision two components with modifier 52
    most surgeons are getting less many than just report 27447.

    I contacted the AMA to ask if they would be changing this policy along
    with the staging of total knee reporting and their reply was that an upcoming
    bulletin will be released updating and clarifying these issues

    Margie Scalley Vaught, CPC, COC, CPC-I, CCS-P, MCS-P, ACS-EM, ACS-OR
    Auditing, Coding, Documentation and Compliance Consulting
    Healthcare Consultant scalley123@aol.com
    cell 360-880-8304
    fax 413-674-7668_www.margievaught.com_ (http://www.margievaught.com/)
    facebook: margie s vaught
    for workshops and audio_ http://www.margievaught.com/calendar/index.cfm_
    (http://www.margievaught.com/calendar/index.cfm)
    Want to receive a monthly newsletter - signup on_ margievaught.com_
    (http://margievaught.com/)
    Check the calendar for audios/webinars and live presentations already
    scheduled - 2016 
  • Has there been any update on this? Looking at trying to code a note for this exact problem. Thanks!
  • This has been an ongoing issue for several years. Has the AAOS requested a conversion code be established like they have for a THR. 27132 is a previous hip surgery converted to a THR, and carries additional RVU's to support the added complexity of having to remove old hardware. We need to urge the AMA to create a code for unicompartment conversion to a TKR.
  • Has there been any update on this? 
  • Actually, we were told by a carrier that we should use 27447.
  • Any update from AMA?
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