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January 2018
Coding Corner Newsletter
Knee Arthroplasty

What To Know When Scheduling Revisions or Replacements:
Your Guide To Avoiding Reimbursement Surprises!!

AMA has come out with recent guidance on coding a Unicompartmental Knee Arthroplasty (UKA). These may sometimes be scheduled as UKA Revision or a UKA conversion to Total Knee Arthroplasty (TKA).

Per the AMA, if a patient had a previous left medial Unicompartmental Knee Arthroplasty (UKA) and now is undergoing left lateral UKA with no revision done to previous medial UKA-
CPT 27446
  • Medicare National Rate: $7,373.99

Knowing what will actually be done is very important. As you will see in the below examples there would be no payment from Medicare .

Replacement of polyethylene liner on previous Medial UKA-
CPT 27599
  • Medicare National Rate: Medicare does not allow for unlisted procedures

Unilateral Knee Arthroplasty (UKA) revised to Total Knee Arthroplasty (TKA)- CPT 27487-52
  • Medicare National Rate: Inpatient only procedure, not payable in ASC

Medicare Pays Separately for Payment Indicator K2 Drugs and J7 Implants New Year New List
Drug/Implant - REVENUE CAPTURED!
Click here for the list of 2018 K2 and J7 indicator HCPCS payable by Medicare

Although CPT 27447 (Total Knee Arthroplasty) has been removed from 2018 Medicare Inpatient Only List, it is still not approved to be performed in an ASC !
Nevro Generator (C1822)-
No Longer Pass Through Device for Medicare!

While under the pass through status Medicare allowed 100% of your cost. As of 01/01/18 Nevro generators are included in the Medicare National Rate for 63685 which is $22,892.26. Leads are still billed under CPT 63650-Medicare National Rate is $4,594.55 each.

Check with your Nevro rep to negotiate your rate!!
Tenex Instrument Procedures-AMA and AHA Advise To Use Unlisted Procedure Codes
The AHA has issued recent guidance stating the tool delivers energy to debride, cut and aspirate damaged tissue, which is not considered a true tenotomy . This echoes previous guidance issued by the AMA stating there is no specific CPT code that accurately describes removal of diseased and damaged tendon or fascia with an ultrasound guided micro tip device.

Reimbursement :                             
Medicare does not allow for unlisted procedures . Coverage varies for commercial insurances and contracted payers.
NSN Revenue Resources, 4511 N. Himes Avenue, Suite 100, Tampa, FL 33614
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