What to Do if Insurance Denies Surgery
What are the risks?
Reasons for the procedure. Knee replacement surgery is a treatment for pain and disability in the knee. The most common condition that results in the need for knee replacement surgery is osteoarthritis. Osteoarthritis is characterized by the breakdown of joint cartilage. Damage to the cartilage and bones limits movement and may cause pain.
653.
Z96. 651 - Presence of right artificial knee joint. ICD-10-CM.
Total knee replacement is classified to code 81.54 and involves replacing the articular surfaces of the femoral condyles, tibial plateau, and patella.
For example, the patient had a total knee arthroplasty 3 years ago. The surgeon removes the femoral component and replaces it with a new component. The surgeon reports CPT code 27486 (revision of total knee arthroplasty, with or without allograft; 1 component).
ICD-10-CM Code for Encounter for surgical aftercare following surgery on specified body systems Z48. 81.
Z48. 81 - Encounter for surgical aftercare following surgery on specified body systems. ICD-10-CM.
81.54 Total knee replacement - ICD-9-CM Vol. 3 Procedure Codes.
ICD-10: Z96. 651, Status (post), organ replacement, by artificial or mechanical device or prosthesis of, joint, knee-see presence of knee joint implant.
CMS also identified CPT code 27446 Arthroplasty, knee, condyle and plateau; medial OR lateral compartment as a Harvard-valued service with Annual Allowed Charges Greater than $10 million.
Report CPT code 29877 (Arthroscopy, knee, surgical; debridement/shaving of articular cartilage [chrondroplasty]) for arthroscopic debridement with presentation of knee pain only, or arthroscopic debridement without lavage for patients with severe osteoarthritis.
Arthroplasty is a surgical procedure to restore the function of a joint. A joint can be restored by resurfacing the bones. An artificial joint (called a prosthesis) may also be used.
For 1-stage revisions, CPT code 27486 (revision of total knee arthroplasty, with or without allograft; 1 component) was used for aseptic 1-component revision; and CPT code 27487 (revision of total knee arthroplasty, with or without allograft; femoral and entire tibial component) was used for aseptic and septic 2- ...