How To Use CPT Code 27438

CPT 27438 describes the procedure of arthroplasty, specifically the replacement of a painful and damaged knee cap with an artificial knee cap prosthesis. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 27438?

CPT 27438 is used to describe the surgical procedure of arthroplasty, specifically the replacement of a painful and damaged knee cap with an artificial knee cap prosthesis. This code is used when the provider makes an incision over the affected knee cap, removes the knee cap, and flattens the tibial and femoral ends to create space for the prosthesis. The prosthesis is then fixed at the site using gum or screws, and the incision is closed with sutures in layers.

2. Official Description

The official description of CPT code 27438 is: ‘Arthroplasty, patella; with prosthesis.’

3. Procedure

1. The provider prepares and anesthetizes the patient.
2. An incision is made over the affected knee cap.
3. The knee cap is removed.
4. The tibial and femoral ends are flattened to create space for the prosthesis.
5. The prosthesis is fixed at the site using gum or screws.
6. Hemostasis is ensured, and the incision is closed with sutures in layers.

4. Qualifying circumstances

CPT 27438 is performed on patients who have a painful and damaged knee cap that requires replacement with an artificial knee cap prosthesis. The procedure is typically performed by a qualified provider who has the necessary expertise in arthroplasty. It is important to note that this code represents a unilateral service, meaning it is performed on one knee. If the provider performs the procedure on both knees, modifier 50 or the RT and LT modifiers should be appended based on payer preference.

5. When to use CPT code 27438

CPT code 27438 should be used when the provider performs the arthroplasty procedure to replace a painful and damaged knee cap with an artificial knee cap prosthesis. It is important to review the full range of codes that apply when the provider performs knee arthroplasty, from arthroplasty of the patella without prosthesis (CPT 27437) to arthroplasty of knee condyles and plateau, medial and lateral compartments, with or without patella resurfacing (CPT 27447).

6. Documentation requirements

To support a claim for CPT 27438, the provider must document the following information:

• Patient’s diagnosis and the need for arthroplasty of the patella
• Details of the procedure performed, including the specific steps taken
• Any additional procedures performed in conjunction with CPT 27438
• Any complications or unexpected findings during the procedure
• Details of the prosthesis used, including the type and size
• Any post-operative instructions or recommendations
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 27438, ensure that the procedure is performed by a qualified provider and that the documentation supports the medical necessity of the arthroplasty. It is important to follow payer guidelines regarding the use of modifiers, such as modifier 50 or the RT and LT modifiers, when the procedure is performed on both knees. It is also recommended to review the full range of codes that apply to knee arthroplasty to ensure accurate coding and billing.

8. Historical information

CPT 27438 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A patient with severe knee pain undergoes arthroplasty of the patella to replace the damaged knee cap with an artificial knee cap prosthesis.
2. An individual who has difficulty walking due to a damaged knee cap receives arthroplasty to improve their mobility and alleviate pain.
3. A patient with a history of knee injuries undergoes arthroplasty of the patella to restore function and stability to the knee joint.
4. An elderly individual with osteoarthritis in the knee undergoes arthroplasty to relieve pain and improve their quality of life.
5. A professional athlete with a knee injury undergoes arthroplasty of the patella to restore their ability to participate in sports.
6. A patient with a congenital knee abnormality undergoes arthroplasty to correct the deformity and improve their overall knee function.
7. An individual with a history of failed conservative treatments for knee pain undergoes arthroplasty of the patella as a last resort to alleviate their symptoms.
8. A patient with a knee cap fracture undergoes arthroplasty to repair the damaged knee cap and restore normal knee function.
9. An individual with a history of recurrent dislocations of the knee cap undergoes arthroplasty to stabilize the knee joint and prevent further dislocations.
10. A patient with a knee cap infection undergoes arthroplasty to remove the infected knee cap and replace it with an artificial knee cap prosthesis.