How To Use CPT Code 27486

CPT 27486 refers to the revision of total knee arthroplasty involving one component, with or without allograft. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 27486 procedures.

1. What is CPT 27486?

CPT 27486 is a medical billing code used to describe a specific surgical procedure involving the revision of total knee arthroplasty, which may include the use of an allograft. This code is utilized by medical coders and billers to accurately document and bill for this particular procedure.

2. 27486 CPT code description

The official description of CPT code 27486 is: “Revision of total knee arthroplasty, with or without allograft; 1 component.”

3. Procedure

The 27486 CPT code procedure involves the following steps:

1. The patient is prepped and anesthetized.
2. The provider exposes the knee joint through the previous skin incision.
3. The patella, or kneecap, is moved outward and the synovium is removed to expose and visualize the joint.
4. Any one of the tibial or femoral components is removed, along with the granulation tissue that might have accumulated over the components.
5. The cement covering the tibial or femoral component is removed, and the component is dislodged.
6. Excess cement is removed from the site.
7. The bone is incised to prepare it for the new prosthesis.
8. An allograft may be used to fix the new prosthesis in place.
9. The new component is secured with cement.
10. Hemostasis is obtained at the surgical site, and the wound is closed by suturing the tissue in layers.
11. A drain may be left in place.

4. Qualifying circumstances

Patients eligible to receive CPT code 27486 services are those who have previously undergone total knee arthroplasty and are experiencing complications or issues with one component of the knee joint. These complications may include loosening, infection, or damage to the prosthesis, which may require revision surgery to prevent further harm to the joint.

5. When to use CPT code 27486

It is appropriate to bill the 27486 CPT code when a provider performs a revision of total knee arthroplasty involving one component, with or without allograft. This code should be used when the procedure is focused on the removal and replacement of a single component of the knee joint, either the tibial or femoral component.

6. Documentation requirements

To support a claim for CPT 27486, the following information should be documented:

• Patient’s medical history and reason for the revision surgery
• Physical examination findings
• Diagnostic imaging results, if applicable
• Details of the surgical procedure, including the component being revised and the use of an allograft, if applicable
• Postoperative care instructions and follow-up plan

7. Billing guidelines

When billing for CPT code 27486, it is essential to ensure that the procedure is accurately documented and supported by the patient’s medical records. Additionally, it is crucial to verify that the code is used appropriately, specifically for revision surgeries involving one component of the knee joint. Providers should also be aware of any payer-specific guidelines or requirements related to billing for this code.

8. Historical information

CPT 27486 was added to the Current Procedural Terminology system in 1990. Since then, there have been updates to the code, including changes in 2010 and Medicare changes in 2017, 2021, and 2022 regarding its inclusion in the Inpatient Only (IPO) list.

9. Similar codes to CPT 27486

Five similar codes to CPT 27486 and how they differentiate are as follows:

1. CPT 27487: This code is used when the provider performs total knee arthroplasty revision of the femoral AND entire tibial component with or without an allograft.
2. CPT 27488: This code is used for the removal of a total knee arthroplasty prosthesis, including the tibial, femoral, and patellar components, without replacement.
3. CPT 27445: This code is used for the arthroplasty of the knee, hinge prosthesis.
4. CPT 27446: This code is used for the arthroplasty of the knee, condyle and plateau, medial and lateral compartments with or without patella resurfacing.
5. CPT 27447: This code is used for the arthroplasty of the knee, condyle and plateau, medial and lateral compartments with or without patella resurfacing, total knee arthroplasty.

10. Examples

Here are 10 detailed examples of CPT code 27486 procedures:

1. Revision of total knee arthroplasty with removal and replacement of a loose tibial component, without allograft.
2. Revision of total knee arthroplasty with removal and replacement of a damaged femoral component, with allograft.
3. Revision of total knee arthroplasty with removal and replacement of a loose femoral component, without allograft.
4. Revision of total knee arthroplasty with removal and replacement of a damaged tibial component, with allograft.
5. Revision of total knee arthroplasty with removal and replacement of a loose tibial component, with allograft.
6. Revision of total knee arthroplasty with removal and replacement of a damaged femoral component, without allograft.
7. Revision of total knee arthroplasty with removal and replacement of a loose femoral component, with allograft.
8. Revision of total knee arthroplasty with removal and replacement of a damaged tibial component, without allograft.
9. Revision of total knee arthroplasty with removal and replacement of a loose tibial component due to infection, with allograft.
10. Revision of total knee arthroplasty with removal and replacement of a damaged femoral component due to infection, without allograft.