RE: knee revision

edited May 2017 in Orthopedics
Can you bill 27486 and 27301 together if it's not a separate incision?

Angela Carter
Reimbursement Manager
Orthopedic Center of IL
PH. 217-547-9217

-----Original Message-----
From: Sandi Hamrick []
Sent: Tuesday, December 16, 2014 7:13 AM
To: Multiple Recipients of Ortho-L
Subject: RE: [ortho-l] knee revision

27486 (revision one component).

-----Original Message-----
Sent: Sunday, December 14, 2014 11:35 PM
To: Multiple Recipients of Ortho-L
Subject: [ortho-l] knee revision

Hi folks,

Any opinions for a cpt code for the following procedure? 27486-22? 27487-52? Unlisted? 27487 seems wrong since the femur was not involved. Thanks for taking a look.

Krisan Schilling, BA, CPC
Medical Coding Specialist
Meriter-UnityPoint Health
Madison WI 53715

1. Polyethylene wear of the patella and tibia.
2. Loosening of the tibial component.
PROCEDURE: Complete revision of the tibia and poly-swap of the metal backed patella.
FINDINGS: Upon inspection of the knee through standard medial parapatellar approach revealed severe polyethylene wear on both the tibia as well as the metal backed patella. There was evidence of metal debris as well as gross loosening of the tibial tray. The decision was then made to proceed with revision of the polyethylene patella as well as a complete revision of the tibia.
DESCRIPTION OF PROCEDURE IN DETAIL: First, the extremity was exsanguinated with an Esmarch bandage. Tourniquet insufflated to 300 mmHg. The prior anterior incision was completely excised and passed from the field. A medial parapatellar approach was utilized. The medial and lateral gutters were exposed and cleaned of synovitis and debris. The joint was inspected. Please see findings for complete list of results. The metal backed patella polyethylene was removed. The tibia was subluxed and the polyethylene removed. The tibial tray was easily removed with complete dissociation between the metal and the cement interface. The cement was then cleaned with osteotomes and curettes. The tibial canal was then sequentially reamed to size 14 were the size 12 appeared to have a better fit given the use of a metaphyseal sleeve. The sleeve was then reamed and debris was removed. The wound was irrigated and the trial components were placed. She achieved full extension. She flexed beyond 90 degrees. Her flexion was limited by her significant thigh girth. A lateral release was performed and there was excellent tracking of the patella upon completion of this. The ligaments were stable to varus and valgus at full extension 30, 60 and 90 degrees of flexion. The trial components were then removed. The wound was again irrigated. The final components were cemented and impacted into position. Cement was only placed along the undersurface of the tibial tray to allow for porous ingrowth of the metaphyseal sleeve. The polyethylene replacement patella was then placed and the leg was placed in full extension and the cement was allowed to cure. Excess was removed with osteotomes and curettes. The tourniquet was deflated and patellar retinaculum was then closed with #1 Vicryl as well as #2 Quill sutures. 
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