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The CPT® Code 27445 refers to the surgical procedure known as knee arthroplasty using a hinge prosthesis, specifically the Walldius type. This procedure is categorized under arthroplasty, which is a surgical intervention aimed at restoring the function of a joint. In the context of knee arthroplasty, there are two primary types of prostheses utilized: hinged and unlinked. The hinged prosthesis, as indicated by this code, is designed to provide stability and support to the knee joint, particularly in cases where there is significant damage or loss of bone structure. The Walldius hinged prosthesis is recognized as a first-generation device, which has largely been supplanted by more advanced models, such as the third-generation S-ROM rotating hinged total knee prosthesis. Hinged prostheses are typically indicated for patients suffering from degenerative joint disease or bone tumors that result in considerable bone loss. They are also employed in situations where complications arise from previously placed unlinked prostheses, such as infections or mechanical failures. The surgical approach involves making an anterior incision over the knee joint, allowing for direct access to the joint capsule. During the procedure, the knee joint is thoroughly inspected, and any bone spurs or soft tissue that may impede function are excised. The procedure is meticulously designed to ensure proper alignment and functionality of the knee joint post-surgery, making it a critical intervention for patients with severe knee joint issues.
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The procedure coded as CPT® 27445 is indicated for specific conditions affecting the knee joint. These include:
The surgical procedure for CPT® 27445 involves several critical steps to ensure the successful implantation of a hinge prosthesis. The process begins with an anterior incision made over the knee joint, providing access to the joint capsule. Once the incision is made, the joint capsule is carefully incised, allowing the surgeon to inspect the knee joint for any abnormalities. During this inspection, bone spurs and any intra-articular soft tissues that may hinder joint function are excised to prepare the joint for the prosthesis. Next, the distal femur is exposed, and an intramedullary alignment system is placed at the end of the femur. This alignment system is crucial as it ensures that the bone cut is made accurately, maintaining the proper alignment of the joint and leg angles. The surgeon then proceeds to cut the bone from the distal end of the femur. Following this, the proximal tibial surface is prepared using either intramedullary or extramedullary alignment rods, mirroring the technique used for the femur. In cases where degenerative joint disease has caused the knee ligaments to contract, the surgeon will release these ligaments to restore normal function. The femur and tibia are then sized and reamed to accommodate the prosthetic components. Trial components are placed to evaluate patellofemoral tracking, particularly if the patella has not been previously removed. If necessary, lateral release or medial reefing is performed to ensure proper tracking of the patella. If significant patellofemoral degenerative joint disease is present, the patella may be resurfaced with a polyethylene button to enhance joint function. Depending on the type of femoral component selected, the stem is inserted into the femur and secured using either a press-fit technique or bone cement. The tibial stem is similarly secured to the proximal tibia. After the components are in place, the range of motion is evaluated to ensure proper function. Finally, the soft tissues and skin are closed in layers to complete the procedure.
Post-procedure care following CPT® 27445 involves monitoring the patient for any complications and ensuring proper recovery. Patients are typically advised on rehabilitation protocols to restore mobility and strength in the knee joint. This may include physical therapy to enhance range of motion and strengthen the surrounding muscles. Pain management strategies are also implemented to ensure patient comfort during the recovery phase. Regular follow-up appointments are essential to assess the function of the hinge prosthesis and to monitor for any signs of complications, such as infection or mechanical failure. Overall, the post-procedure care is critical for achieving optimal outcomes and ensuring the longevity of the knee prosthesis.
| Short Descr | REVISION OF KNEE JOINT | Medium Descr | ARTHROPLASTY KNEE HINGE PROSTHESIS | Long Descr | Arthroplasty, knee, hinge prosthesis (eg, Walldius type) | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P3C - Major procedure, orthopedic - Knee replacement | MUE | 1 | CCS Clinical Classification | 152 - Arthroplasty knee |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | GZ | Item or service expected to be denied as not reasonable and necessary | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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