How To Use CPT Code 27446

CPT 27446 refers to the arthroplasty procedure for the knee, specifically focusing on the medial or lateral compartment. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 27446.

1. What is CPT 27446?

CPT 27446 is a medical procedure code used to describe the arthroplasty of the knee, specifically focusing on the medial or lateral compartment. This procedure involves the reconstruction of the diseased or damaged knee joint to relieve pain and improve the patient’s gait. The code is used by medical professionals to accurately document and bill for this specific type of knee surgery.

2. 27446 CPT code description

The official description of CPT code 27446 is: “Arthroplasty, knee, condyle and plateau; medial OR lateral compartment.”

3. Procedure

The 27446 procedure involves the following steps:

1. The patient is appropriately prepped and anesthetized.
2. An incision is made over the affected knee.
3. The patella is removed, and the tibial and femoral ends are excised to make space for the prosthesis.
4. The damaged meniscus and surrounding structures are excised.
5. The femoral condyles and tibial plateaus may also be excised.
6. Holes are drilled to insert the prosthesis, which is fixed with screws or gum.
7. The prosthesis can be cemented or noncemented.
8. The site is flushed with sterile saline, hemostasis is assured, and the incision is closed with sutures.

4. Qualifying circumstances

Patients eligible to receive CPT code 27446 services are those who have a diseased or damaged medial or lateral compartment of the knee joint. This may be due to conditions such as osteoarthritis, rheumatoid arthritis, or post-traumatic arthritis. The patient should have significant pain, functional limitations, and a reduced quality of life due to the knee joint issue. Conservative treatments, such as physical therapy, medications, and injections, should have been tried and proven ineffective before considering surgery.

5. When to use CPT code 27446

It is appropriate to bill the 27446 CPT code when a provider performs a knee arthroplasty specifically targeting the medial or lateral compartment of the knee joint. This code should be used when the procedure involves the reconstruction of the knee joint, including the femoral condyles and tibial plateaus, to alleviate pain and improve the patient’s gait.

6. Documentation requirements

To support a claim for CPT 27446, the following information should be documented:

• Patient’s medical history and physical examination findings
• Diagnostic imaging results (e.g., X-rays, MRI) confirming the knee joint issue
• Conservative treatments tried and their outcomes
• Indications for surgery, including pain, functional limitations, and reduced quality of life
• Details of the surgical procedure, including the specific compartment addressed, prosthesis used, and surgical technique
• Postoperative care plan and follow-up appointments

7. Billing guidelines

When billing for CPT code 27446, it is essential to follow the appropriate guidelines and rules. Some tips for billing this code include:

• Ensure that the documentation supports the medical necessity of the procedure.
• Use the appropriate modifiers, such as RT and LT for right and left knees, or modifier 50 for bilateral procedures, depending on payer preference.
• Be aware of any payer-specific requirements or guidelines for billing this code.

8. Historical information

CPT 27446 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Similar codes to CPT 27446

Five similar codes to CPT 27446 and how they differ are:

• CPT 27437: This code is for arthroplasty of the patella without a prosthesis.
• CPT 27447: This code covers arthroplasty of the knee condyles and plateau, including both medial and lateral compartments, with or without patella resurfacing.
• CPT 27438: This code is for arthroplasty of the patella with a prosthesis.
• CPT 27442: This code is for arthroplasty of the knee, including the femoral condyles and tibial plateaus, without a prosthesis.
• CPT 27445: This code is for arthroplasty of the knee, including the femoral condyles and tibial plateaus, with a prosthesis.

10. Examples

Here are 10 detailed examples of CPT code 27446 procedures:

1. A 65-year-old patient with severe osteoarthritis in the medial compartment of the left knee undergoes a CPT 27446 procedure to alleviate pain and improve mobility.
2. A patient with post-traumatic arthritis in the lateral compartment of the right knee undergoes a CPT 27446 procedure after conservative treatments have failed.
3. A patient with rheumatoid arthritis and significant damage to the medial compartment of the left knee undergoes a CPT 27446 procedure to improve their quality of life.
4. A patient with a history of multiple knee surgeries and persistent pain in the lateral compartment of the right knee undergoes a CPT 27446 procedure to address the issue.
5. A patient with severe osteoarthritis in the medial compartment of both knees undergoes a bilateral CPT 27446 procedure to alleviate pain and improve mobility.
6. A patient with a history of knee instability and significant damage to the lateral compartment of the left knee undergoes a CPT 27446 procedure to restore stability and function.
7. A patient with a complex knee deformity and severe pain in the medial compartment of the right knee undergoes a CPT 27446 procedure to correct the deformity and alleviate pain.
8. A patient with a history of failed knee surgeries and persistent pain in the medial compartment of the left knee undergoes a CPT 27446 procedure to address the issue.
9. A patient with a history of multiple knee injuries and significant damage to the lateral compartment of the right knee undergoes a CPT 27446 procedure to restore function and alleviate pain.
10. A patient with severe osteoarthritis in the medial compartment of the left knee undergoes a CPT 27446 procedure using a cemented prosthesis to alleviate pain and improve mobility.