CPT 27447

(2022) CPT 27447 Description, Guidelines, Reimbursement, Modifiers & Examples

CPT 27447 bills for service when the physician performs arthroplasty of knee, plateau, condyle, lateral and medial compartments with or without patella resurfacing (total knee arthroplasty). The physician performs total knee replacement surgery with artificial knee parts.

CPT 27447 Description 

The following are the reasons why total knee replacement surgery performs by the physician:

Osteoarthritis is the inflammation of joints that occurs in 50 or older people.

Rheumatoid arthritis: synovial membrane becomes thickened and inflamed around the joint.

Post-traumatic arthritis may occur due to severe knee injury that leads to total knee replacement.

The Physician exchanges most of the knee joint, such as severely damaged or worn cartilage. He makes a small incision in a midline over the knee. 

The physician replaces severely damaged or worn cartilage of the knee joint. A midline incision makes over the knee, and dissection exposes the knee joint. The physician may release soft tissues and ligaments to correct deformities and improve range of motion. 

The physician uses a cutting-alignment jig placed on the upper tibia to remove the tibial joint surface (medial and lateral compartments) by making a bone cut. A cutting-alignment jig is also used on the femoral condyles to make the appropriate bone cut. 

Depending on the integrity of the joint surface of the patella, the physician may also make a bone cut to remove damaged cartilage. If the joint surface is not healthy, it is only required otherwise left intact. 

The physician repairs the incision in layers with staples, sutures, and or Steri-strips. The physician secures the with glue and or bone screws. Peg holes create by the physician, and the prosthesis components incorporate into the tibia, femur, and the patella if needed. 

cpt code 27447

CPT 27447 bills for service when the physician performs arthroplasty of knee, plateau, condyle, lateral and medial compartments with or without patella resurfacing (total knee arthroplasty). 

CPT 27447 Reimbursement

A maximum of one unit can be a bill on the same service date of CPT 27447. In contrast, the Two units allow documentation supporting the service’s medical necessity. 

The cost and RUVS of CPT 27447 are $1400.35 and 40.46530 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 27447 are $1400.35 and 40.46530 when enacted in the non-facility.

CPT 27447 Modifiers  

The following are the list modifiers applicable with CPT 27447 : 

22, 23, 47, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 76, 77, 78, 79, 80, 81 82, 99, , AS, CC, CR, ET, EY, GA, GC, GK, GR, GU, GY, GZ, KX, Q5, Q6, QJ, SG, TC, XR, XP, XU, XS, AI, AQ, AR. 

Modifier 47 is applicable CPT 27447 when the surgeon administers general or regional anesthesia to the patient. It is not appropriate to report modifier 47 with anesthesia procedures.

Modifier 76 is appropriate with CPT 27447 when a similar service performs by the Same Physician on the same service date. 

Modifier 54 is applicable with CPT 27447 when the physician provides surgical care only. In contrast, Modifiers 55 and 56 attach to CPT 27447 when the physician performs post-management and preoperative care only. 

Modifier 76 is applicable with CPT 27447 when a similar service performs by a different Physician on the same service date. 

Modifier 59 is applicable with CPT 27447 when a Distinct service performs by the physician and bundles with another procedure on the same date.   

Modifier X {E, P, S, U} is applicable instead of Modifier 59 with CPT 27447 when service bills to medicare insurance. It divides the modifier into four parts for further specification of the procedure. 

Modifier 53 will be reported with CPT 27447 if an unsuccessful attempt for arthroplasty of the knee makes due to unavoidable circumstances like allergic reactions to the substance. 

Modifier 22 applies to CPT 27447 when services perform longer than usual and take extra resources during the procedure. 

Modifier 23 is applicable with CPT 27447 when general or local anesthesia administers by the physician and routinely does not require during the procedure. 

Modifier 52 applies when the physician does not complete the immunization service and terminates due to unavoidable circumstances. 

If physicians believe that Medicare will deny such service, reporting with a GA modifier is appropriate. The beneficiary must sign an Advance Beneficiary Notification (ABN), and CPT 27447 must apply the GA modifier to that service.

CPT 27447 Billing Guidelines

Documentation should support the medical necessity of service. It reflects that service is medically necessary and appropriate.

The following are the most used payable dx codes for CPT 27447:

M05.061, M05.062, M05.069, M06.061, M06.062, M06.069, M17.11, M17.12, M12.561, M12.562, M12.569

CPT 27447 includes medial and lateral compartments and reports for total knee replacement, and It is not appropriate to report sedately.

Suppose knee arthroplasty with medial or lateral compartment performs in addition to CPT 27447. In that case, it is appropriate to report CPT code 27446 with modifier 59.

Suppose revision of a total knee arthroplasty performs in addition to CPT 27447. In that case, it is appropriate to report CPT code 27487 with modifier 59.

Suppose revision of a total knee arthroplasty performs with one compartment in addition to CPT 27447. In that case, it is appropriate to report CPT code 27486 with modifier 59.

Suppose removal of a total knee prosthesis performs in addition to CPT 27447. In that case, it is appropriate to report CPT code 27488 with modifier 59.

CPT 27447 Examples

The following are the examples when CPT 27447 bills:

Example 1

A 60-year-old female presents with knee pain for four days to the office. The pain gets worse with movement and when lying down. The patient took some medication for pain. 

The physical exam revealed swelling in the knee region. The physician ordered a CT of the Knee, and it showed degeneration of the knee joint. The patient also has effusion of both knees. The patient denies any other symptoms such as headache, numbness, urinary problems, nausea, vomiting, and shortness of breath. 

The physician consulted with orthopedics and suggested total knee arthroplasty. The physician scheduled the total Knee arthroplasty for next week, and he was prescribed medications for further treatment. 

Example 2

A sixteen-year-old male presented to the emergency department after a motor vehicle accident today and had a severe headache, back pain, and knee pain. The patient is unable to move and has severe knee pain. 

The patient denies urinary symptoms, extremity pain, and dizziness, and the physical exam revealed neck and eye swelling. The physician ordered a CT of the Knee, head, and the Lumbar. It revealed traumatic injury of the knee.

The physician consulted with orthopedics and suggested total knee arthroplasty. The physician scheduled the total Knee arthroplasty for next week, and he was prescribed medications for further treatment. 

Example 3 

A 39-year-old male presents to the office with degenerative changes in the knee joint with c/o constant low back pain that started four days ago. The patient was unable to walk for 1-week. 

The patient is consulted with his primary care physician and suggested to go emergency department. Denies trauma, heavy palpitations, dizziness, cough, recent illness, fever, chills, back pain, abdominal pain, nausea, recent travel, known sick contacts, current antibiotic use, near-syncope or syncope, changes in stool color, urinary complaints, or any other symptoms. 

The physician decides to do a surgical procedure to operate on the knee. The patient took his routine medication. The physician ordered a CT scan of the Knee joint to confirm if the patient has osteoarthritis. The procedure performs successfully.

The physician consulted with orthopedics and suggested total knee arthroplasty. The physician scheduled the total knee arthroplasty for next week, and he was prescribed medications for further treatment. 

Example 4

A 76-year-old male presents to the office for rheumatoid arthritis of the knee. A patient has had severe right leg pain since last week. 

The patient took some medication for pain but is getting worse day by day. He denies trauma, heavy palpitations, dizziness, cough, recent illness, fever, chills, back pain, abdominal pain, nausea, recent travel, known sick contacts, current antibiotic use, near-syncope or syncope, changes in stool color, urinary complaints, or any other symptoms. 

The CT scans of the knee joint show degeneration, effusion, and other knee joint disorders. 

The physician consulted with orthopedics and suggested total knee arthroplasty. The physician scheduled the total knee arthroplasty for next week, and he was prescribed medications for further treatment. 

Example 5

A 65-year-old female presents to the office with knee Osteoarthritis and knee pain. The pain gets worse with movement and when lying down. The patient took some medication for pain. The pain gets resolved for a few hours and starts again.

The patient denies any other symptoms such as headache, numbness, urinary problems, nausea, vomiting, and shortness of breath. A physical exam revealed swelling in the Knee region. 

The physician ordered a CT scan of the knee. It reveals knee joint degeneration, effusion, and other joint disorders. The physician consulted with orthopedics and suggested total knee arthroplasty. The physician scheduled the arthroplasty of the total knee for next week, and he was prescribed medications for further treatment. 

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