Summary & Overview
CPT 27487: Revision of Total Knee Arthroplasty, With or Without Allograft
CPT code 27487 covers the revision of total knee arthroplasty, a major orthopedic surgery performed to address complications or failures of a previous knee replacement. This procedure is essential for patients experiencing pain, mechanical issues, or other problems related to their knee prosthesis. Nationally, revision knee arthroplasty is a significant clinical service, with implications for patient outcomes, hospital resources, and payer policies.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. These organizations play a central role in coverage and reimbursement for inpatient orthopedic procedures, impacting both providers and patients across the country.
Readers will gain insight into the clinical context of 27487, including its role in orthopedic surgery, typical hospital settings, and relevant coding practices. The publication also highlights important billing modifiers, associated taxonomies, and ICD-10 diagnoses commonly linked to revision knee arthroplasty. Policy updates and benchmarks are discussed to provide a comprehensive overview of how this procedure is managed within the healthcare system. This summary serves as a resource for understanding the national landscape of revision knee arthroplasty, including payer coverage and coding considerations.
CPT Code Overview
CPT code 27487 represents the revision of total knee arthroplasty, with or without allograft. This procedure is a complex orthopedic surgery performed to address issues with a previously implanted knee prosthesis, such as mechanical complications or persistent pain. The typical site of service for this procedure is an inpatient hospital setting, reflecting the intensive nature of the surgery and the need for postoperative care. Revision knee arthroplasty is a critical intervention for patients experiencing failure or complications of their initial knee replacement, aiming to restore function and alleviate symptoms.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult who previously underwent total knee arthroplasty and is now experiencing pain, mechanical complications, or failure of the prosthetic knee joint. The patient may present with symptoms such as persistent knee pain, instability, or decreased function. After clinical evaluation and imaging, the orthopedic surgeon determines that revision of the total knee arthroplasty is necessary. The procedure is performed in an inpatient hospital setting, often by a specialist in adult reconstructive orthopedic surgery. The workflow includes preoperative assessment, surgical revision (with or without allograft), and postoperative care.
Coding Specifications
- Modifier
52: Reduced services — used when the procedure described by CPT code27487is performed in a reduced manner, such as partial component exchange rather than a full revision.
| Modifier Code | Description | When Used |
|---|---|---|
52 | Reduced services | Partial component exchange or less than full revision |
Associated Provider Taxonomies:
207X00000X— Orthopaedic Surgery207XX0004X— Adult Reconstructive Orthopaedic Surgery207XS0114X— Orthopaedic Surgery of the Spine
These taxonomies represent providers specializing in orthopedic surgery, with a focus on adult reconstructive procedures and, in some cases, spine surgery.
Related Diagnoses
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T84.84XA: Pain due to internal orthopedic prosthetic devices, implants and grafts, initial encounter- Indicates the patient is experiencing pain related to the knee prosthesis, often prompting revision surgery.
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T84.83XA: Mechanical complication of internal joint prosthesis, initial encounter- Refers to mechanical issues such as loosening, breakage, or instability of the knee prosthesis, necessitating revision.
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M17.10: Unilateral primary osteoarthritis, unspecified knee- Describes osteoarthritis affecting one knee, which may have led to the initial arthroplasty and subsequent revision.
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M17.9: Osteoarthritis of knee, unspecified- General diagnosis of knee osteoarthritis, relevant for patients with ongoing joint degeneration.
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Z96.651: Presence of right artificial knee joint- Indicates the patient has a right knee prosthesis, relevant for documentation and coding of revision procedures.
Related CPT Codes
27486— Revision of total knee arthroplasty, with or without allograft (other component)
Clinical Relationship:
- CPT code
27486is closely related to27487and may be used in similar clinical workflows. Both codes describe revision procedures for total knee arthroplasty, but may differ based on the specific components revised. - These codes are alternatives depending on the extent and nature of the revision. They are not typically used together for the same knee during a single encounter.
National Reimbursement Benchmarks
National mean rates for CPT code 27487 show that Medicare reimburses at $1,595.58, while the average commercial benchmark (BUCA) is higher at $2,271.80. Among individual commercial payers, UnitedHealth Group has the highest mean rate at $3,159.06, and Aetna is the lowest at $1,584.28.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Medicare has the tightest range ($115.00), indicating relatively consistent rates. In contrast, Cigna ($1,716.00) and UnitedHealth Group ($1,822.00) exhibit the widest ranges, reflecting greater variability in commercial reimbursement. Blue Cross Blue Shield and BUCA have moderate dispersion, while Aetna's range is $834.87.
The table and chart below present a detailed breakdown of national payer benchmarks for CPT code 27487, including mean rates and percentile values.
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