Summary & Overview
CPT 27447: Total Knee Arthroplasty (Complete Knee Replacement)
CPT code 27447 is a nationally recognized billing code for total knee arthroplasty, a procedure that replaces both the medial and lateral compartments of the knee joint, often addressing advanced joint disease and improving patient outcomes. This code is central to orthopedic surgery practices and is most commonly performed in inpatient hospital settings. The procedure is covered by major payers including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, reflecting its widespread clinical and financial significance.
This publication provides a comprehensive overview of 27447, including payer coverage, clinical context, and policy updates relevant to orthopedic surgery. Readers will gain insights into benchmarks for utilization, reimbursement trends, and the evolving landscape of medical necessity criteria. The analysis also highlights the importance of accurate coding and documentation for total knee arthroplasty, ensuring compliance with payer requirements and facilitating appropriate reimbursement. Key modifiers and associated diagnoses are discussed to clarify billing nuances and support clinical decision-making. The report is designed for healthcare professionals, administrators, and policy analysts seeking up-to-date information on this essential orthopedic procedure.
CPT Code Overview
CPT code 27447 represents a total knee arthroplasty, a surgical procedure involving the replacement of both the medial and lateral compartments of the knee condyle and plateau, with or without resurfacing of the patella. This procedure is classified under orthopedic surgery and is typically performed in an inpatient hospital setting (Place of Service 21). Total knee arthroplasty is a critical intervention for patients with severe knee joint disease, providing significant improvement in mobility and quality of life.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult patient with advanced degenerative joint disease, such as rheumatoid arthritis or malignant neoplasm affecting the knee, who has failed conservative management and requires surgical intervention. The patient is admitted to an inpatient hospital setting for a total knee arthroplasty, where both the medial and lateral compartments of the knee are replaced, with or without resurfacing of the patella. The procedure is performed by an orthopedic surgeon, often specializing in general orthopaedic surgery, orthopaedic trauma, or orthopaedic surgery of the spine. The clinical workflow includes preoperative assessment, imaging, surgical planning, intraoperative management, and postoperative care, including physical therapy and monitoring for complications.
Coding Specifications
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Modifiers:
RT: Indicates the procedure was performed on the right side.LT: Indicates the procedure was performed on the left side.50: Used when the procedure is performed bilaterally.22: Applied when the procedural services are increased due to complexity or additional work.
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Provider Taxonomies: