Nurse Visit

edited May 2017 in Orthopedics
If a nurse takes vitals on a patient along with an intake note and then the patient decides to leave can a 99211 be billed as incident to?

From: Rhonda Drinnon []
Sent: Wednesday, May 25, 2016 10:01 AM
To: Multiple Recipients of Ortho-L
Subject: Re: [ortho-l] 2 stage revision TKA

The AAOS issued guidance on this in 2006 and 2013 stating 27447. On December 5, 2008 - Orthopedic Pink Sheets had an article detailing this information and had quotes from the AMA to use 27447 in this scenario. The AMA's statement was: "If the prosthesis has already been removed for infection, then a revision code is not correct, as they have already been compensated for taking things out. If they used the revision code they are getting paid for something they are not doing, i.e., taking out the components". The did go onto say that a "modifier 22 could be appended to 27447, if justified".

Fortunately for the hip we have a conversion code (27132) but nothing along those lines for the knee.

Rhonda Vance Drinnon, CPC

In the words of Jerry McGuire... "Help me help you".

On Tue, May 24, 2016 at 8:04 PM, Hanohano, Penny wrote:

Just wondering, total knee arthroplasty that is infected. Physician explants prosthesis and inserts antibiotic spacer. After 10 weeks, infection is cleared, patient taken back to the OR for removal of spacer and revision TKA.

AAOS defines a revision as removing old components and replacing with new in one surgical session. Is the spacer considered a “component”?

Physician states that even if this is a 2 stage procedure, it’s a revision and should be coded with 27487. I’m saying it’s 27447. I read Mary LeGrand’s article in the February 2013 issue of AAOS NOW. It sounds like it is not a revision.

Any comments/feedback/opinions would be greatly appreciated. OR if anyone has any sites they can refer me too that can help clear me understand the process, would help!

Thank you ☺

Penny K. Hanohano, CPC
Physician Liaison

"I can do all things through Him who strengthens me."`Philippians 4:13
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