(2023) CPT Codes For Total Knee Arthroplasty (TKA) | Description, Guidelines, Reimbursement, Modifiers & Examples

The CPT codes for Total Knee Arthroplasty (TKA) are CPT 27486, CPT 27487, and CPT 27488. The entire knee prosthesis is removed and replaced as the final operation in knee replacement surgery. Total Knee Arthroplasty with or without allograft includes the femoral and entire tribal components. 

Description Of The CPT Codes For Total Knee Arthroplasty

Knee Replacement Arthroplasty is effective and medically necessary in some circumstances. The surgeon enters the CPT code for Total Knee Arthroplasty 27486 to revise total knee arthroplasty. Treatment for an infected joint procedure code(s) is an insertion (11981), removal (19982), and replacement of an antibiotic-impregnated cement spacer are all covered by these three codes (11983). 

All types of hip and knee arthroplasty procedures, including primary, revision, and conversion to total hip arthroplasty, are described by the CTP code. There is no CPT code for a complete knee arthroplasty conversion. 

In addition to restoring joint function, a common replacement procedure can help alleviate discomfort. Pain and dysfunction in the joints can persist despite the best efforts of drugs and physical therapy. 

As the name suggests, knee arthroplasty is a surgical process in which a damaged knee may replace. Typically affects middle-aged and older people and can lead to knee joint cartilage and bone degeneration. Several metal components cover the ends of the bones that make up the knee joint and the kneecap. 

The knee can be affected by a variety of rheumatoid arthritis. Part of the knee is replaced in one of the compartments by a technique called UKA (also known as a partial knee replacement). Those with knee arthritis in the anterior or posterior components may benefit from this less invasive total knee replacement procedure.

This procedure is a partial replacement because the anterior and posterior cruciate ligaments are intact. For a partial replacement, the incision is smaller. As a result, there may be less postoperative pain and a faster recovery time with UKA than with TKA, as there is less dissection and hence minor surgery.

Because only one knee compartment is affected, doctors may choose a UKA over a TKA even though the former is less prevalent.

Surgical treatment for an infection might be one or multiple phases long, depending on the organism’s aggressiveness. Staged care involves treating the disease in two sessions. The first consists of removing the previous prosthesis, either with an antibacterial spacer or by dragging and re-inserting one are important.

The surgeon for arthrotomy, knee, exploration, drainage, or foreign body removal will not list CPT code for Total Knee Arthroplasty 27310-78. The surgeon’s replacement for the poly liner will be performed with no revision or staged surgery. The main reason is Osteoarthritis from previous joint use or a lack of exercise compliance. It is not an issue if it does not show up as a postoperative issue.

The American Medical Association manages the CPT code for Total Knee Arthroplasty 27487, a medical procedure code for Femur (Thigh) and Knee Joint Replacement, Revision, and Reconstruction procedures.

This procedure aims to reduce the pain and disability caused by a severely damaged knee. In this procedure, surgeons remove and replace the knee joint that has damaged weight-bearing surfaces with metallic or other rigid materials. Her patella may or may not return with a prosthesis. 

Total knee arthroplasty (TKA) is a significant medical advancement for Medicare coverage issues. Arthroplasty is the most common treatment option for patients who suffer from the knee and disjoint infections. The term “replacement total knee arthroplasty” refers to this procedure. 

A vital part of a successful revision procedure is restoring the original procedure’s details that failed. Reducing discomfort and enhancing the patient’s ability to perform daily activities are the primary goals of total knee replacement surgery. 

It causes inflammation in the synovial membrane and overproduction of synovial fluid Osteoarthritis is a degenerative joint condition. The removal of knee prosthesis and the subsequent replacement with cement or a prosthetic spacer is 27488. 

A patient may benefit from a total hip arthroplasty treatment to remove and re-implant the knee prosthetic six weeks later; the same surgeon returns to surgery. CTP code is offered strictly for educational purposes and does not make any promises or representations regarding reimbursement rates.

Not to improve or maximize any payer’s compensation. All of the codes provided are for the same purpose.

Using these codes does not imply or ensure they are appropriate for payment and medical treatment. Verification of the information is the responsibility of the healthcare provider. The in-depth knowledge of their payer organizations’ regulations and payment procedures

A total knee replacement procedure must be completed in the same surgical session to be eligible for a CPT code for Total Knee Arthroplasty 27487; therefore, listing either of these procedures with the revision number 27487 would be erroneous. Staged management necessitates the removal of the previous prosthesis during the first operation. This management may perform ith either with or without the insertion of an antibacterial spacer.

At one time, all of the old prosthetic parts were removed and replaced with new ones in this type of surgery. They underwent a knee arthroplasty three years ago, for example. The surgeon removes and replaces the femoral component. 

CPT code 11981 and CPT code 27091 or 27488 for prosthesis and antibacterial drugs cement spacer. Using CPT code 11982, total hip arthroplasty (27132) or total knee replacement (27447). 

The surgeon types the CPT code 27310-78 into the knee replacement for exploration, drainage, or infection removal. Despite the doctor replacing the poly liner, this is not a significant update or a second surgery.

Billing Guidelines

Total Knee Arthroplasty (TKA) procedures treat degenerative joint diseases. Outpatient Prospective Payment System (OPPS) does not cover operations and services generally provided only in a hospital setting, according to the Medicare IPO list (OPPS). 

CMS reviews and updates this list annually and publishes it as Addendum E to the OPPS final rule to stay abreast of new surgical techniques and medical advances. The number of surgeries performed on patients under 60 has increased due to technological advancements and surgical procedures.

Several issues remain unresolved following the removal of the IPO list, including the paperwork requirements, post-acute skilled nursing facility care, the Two-Midnight Rule’s impact, and the CJR program.

As a result of Medicare Advantage insurers urging networks to convert most TKAs to outpatient status, a misunderstanding ensued, leading to doctors believing that outpatient should be the default setting. According to CMS, most TKAs will continue to be conducted within the hospital setting because only many Medicare patients will benefit from outpatient TKAs.

How To Use Modifiers With The CPT Codes For Total Knee Arthroplasty

This procedure did not qualify as a staged, planned, or more sophisticated surgery than TKA despite discussing the risk of arthrofibrosis with the patient. Staged or related procedures carried out during the first surgery’s postoperative or global period are associated with modifier 58. 

CPT codes for subsequent procedures include a modifier to indicate if they were planned prospectively during the first procedure (staged), whether they were more thorough surgeries than the original procedure, or whether they were therapy following a diagnostic surgical procedure.

 Modifier 58 is necessary since the surgical field has evolved and the procedure has gotten more complex. It is important for orthopedic surgeons to accurately document a patient’s medical history to avoid coding mistakes.

Despite the doctor’s use of “staged” in his operating plan, Modifier 58 is inappropriate. It is utilized for all subsequent surgeries on the same body part during a time of international use. 

It is possible to have the first operation on either the right or left carpal tunnel and a second procedure on either the left or right carpal tunnel. This procedure did not qualify as a staged, planned, or more sophisticated surgery than TKA despite discussing the risk of arthrofibrosis with the patient.

Reimbursement

CMS deems TKA a “device-intensive operation” when comparing payment amounts between various service sites. Implantable devices used during surgery are rewarded appropriately under this method for the ASC’s time and effort. There is no difference in payment between ASC and OPPS for any device-related procedure element.

The hospital outpatient facility and the ASC share the cost of the gadget. The ASC’s expected lower overhead over a hospital outpatient department accounts for the difference.

There is a continuous need to examine recent developments in orthopedic physician reimbursement rates as the US Centers for Medicare & Medicaid Services (CMS) scrutinize orthopedic physician expenses. 

However, to our knowledge, no comparable study has compared the overall physician expenses for these two procedures. We wanted to see how Medicare physician reimbursements for septic and aseptic revision TKAs had changed over time.

Septic revision TKAs have depreciated more than aseptic ones in two decades. According to our findings, septic revision TKAs may burden doctors financially, limiting access to treatment for patients with prosthetic joint infections. 

Example

A 78-year-old male patient performed the test of complete knee arthroplasty. Irrigation and debridement are performed during the global phase by the surgeon. After the treatment, the surgeon removes the polyline and replaces it with a new one to obtain access to the posterior knee.