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.
In checking around, it still seems to be accurate.