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AHA Coding Clinic® for HCPCS - 2021 Issue 2; Ask the Editor

Extensor mechanism reconstruction

Patient status post left total knee arthroplasty (TKA) presents with periprosthetic patellar fracture and extensor mechanism disruption. A midline incision was made which exposed the infrapatellar tendon, quadriceps, a loose patellar button and a fragmented patella, which was excised. Retinacular tissues were preserved for the reconstruction and quadriceps tendon was split into two segments. Drill holes were made into the tibia that was prepared with a bone graft and an allograft. The allograft was secured with tension wires and screws and additionally secured with sutures to the quadriceps tendon segments. The quadriceps was sewn over the graft. The retinacular tissue preserved earlier, was cut to the appropriate length and tensioned. The knee was put through range of motion (ROM) and the patella was appropriately placed as seen on intraoperative x-ray. The surgical wound was closed in layers.Is the quadriceps and/or patellar tendon repair included with the patellectomy? Is there a code for the repair of the extensor mechanism? Would CPT code 27350 alone or 27350 and 27599 be appropriately reported? ...

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