Knee Systems Coding Reference Guide - Joint …

1 PhysicianCPT CodeCPT Description274 4 5 Arthroplasty, knee , hinge prosthesis (eg, walldius type)274 4 6 Arthroplasty, knee , condyle and plateau; medial or lateral compartment274 47 Arthroplasty, knee , condyle and plateau; medial and lateral compartments with or without patella resurfacing (total knee arthroplasty)Physician RevisionCPT CodeCPT Description274 8 6 Revision of total knee arthroplasty, with or without allograft; 1 component274 87 Revision of total knee arthroplasty, with or without allograft; femoral and entire tibial componentHospital Outpatient and Free-Standing Ambulatory Surgery Center (ASC)CPT CodeCPT DescriptionOPPS Status IndicatorAPCASC Payment Indicator274 4 5 Arthroplasty, knee , hinge prosthesis (eg, walldius type)C--NA274 4 6 Arthroplasty, knee , condyle and plateau; medial or lateral compartmentJ15 115J8274 47 Arthroplasty, knee , condyle and plateau; medial and lateral compartments with or without patella resurfacing (total knee arthroplasty)C--NA274 8 6 Revision of total knee arthroplasty, with or without allograft; 1 componentC--NA274 87 Revision of total knee arthroplasty, with or without allograft; femoral and entire tibial componentC--NAOPPS Outpatient Prospective Payment system .

2 APC Ambulatory Payment ClassificationStatus Indicator C Not paid under OPPS; J1 - Hospital Part B services paid through a comprehensive APCAPC 5115 Level 5 Musculoskeletal ProceduresPayment Indicator J8 Device-intensive procedure; paid at adjusted rate; NA This procedure is not on Medicare s List of ASC Covered Surgical InpatientMS-DRG and Description*469 Major Joint replacement Or Reattachment of Lower Extremity with MCC470 Major Joint replacement Or Reattachment of Lower Extremity without MCC466 Revision Of Hip Or knee replacement with MCC467 Revision Of Hip Or knee replacement with CC468 Revision Of Hip Or knee replacement without CC/MCCCC Complication and/or Comorbidity, MCC Major Complication and/or Comorbidity*MS-DRG Medicare Severity Diagnosis Related Group.

3 Other MS-DRGs may applyKnee Systems Coding Reference GuideICD-10-PCS CodeICD-10-PCS Description SRC J9 replacement of right knee Joint with synthetic substitute, cemented, open approach SRC JAReplacement of right knee Joint with synthetic substitute, uncemented, open approach SRC JZReplacement of right knee Joint with synthetic substitute, open approach SRD J9 replacement of left knee Joint with synthetic substitute, cemented, open approach SRD JAReplacement of left knee Joint with synthetic substitute, uncemented, open approach SRD JZReplacement of left knee Joint with synthetic substitute, open approach SRT J9 replacement of right knee Joint , femoral surface with synthetic substitute, cemented, open approach SRT JAReplacement of right knee Joint , femoral surface with synthetic substitute, uncemented, open approach SRT JZReplacement of right knee Joint , femoral surface with synthetic substitute, open approach SRU J9 replacement of left knee Joint , femoral surface with synthetic substitute, cemented, open approach SRU JAReplacement of left knee Joint , femoral surface with synthetic substitute, uncemented, open approach SRU JZReplacement of left knee Joint , femoral surface with synthetic substitute, open approach SRV J9 replacement of right knee Joint , tibial surface with synthetic substitute, cemented, open approach SRV JAReplacement of right knee Joint , tibial surface with synthetic substitute, uncemented.

4 Open approach SRV JZReplacement of right knee Joint , tibial surface with synthetic substitute, open approach SRW J9 replacement of left knee Joint , tibial surface with synthetic substitute, cemented, open approach SRW JAReplacement of left knee Joint , tibial surface with synthetic substitute, uncemented, open approach SRW JZReplacement of left knee Joint , tibial surface with synthetic substitute, open approachRevision SWC JZRevision of synthetic substitute in right knee Joint , open approach SWC4 JZRevision of synthetic substitute in right knee Joint , percutaneous endoscopic approach SWD JZRevision of synthetic substitute in left knee Joint , open approach SWD4 JZRevision of synthetic substitute in left knee Joint , percutaneous endoscopic approachHCPCSHCPCS CodeHCPCS DescriptionC 17 76 Joint device (implantable)HCPCS Healthcare Common Procedure Coding SystemNote: C-codes report devices used in conjunction with outpatient procedures billed and paid for under Medicare OPPSFor further assistance with Coding and reimbursement questions, contact the Zimmer Biomet Reimbursement Hotline at 866-946-0444 or Procedural Terminology (CPT ) copyright 2016 American Medical Association.

5 All rights reserved. CPT is a registered trademark of the American Medical Biomet Coding Reference Guide Disclaimer The information in this document was obtained from third party sources and is subject to change without notice, including as a result in changes in reimbursement laws, regulations, rules and policies. All content in this document is informational only, general in nature and does not cover all situations or all payers rules or policies. The service and the product must be reasonable and necessary for the care of the patient to support reimbursement. Providers should report the procedure and related codes that most accurately describe the patients medical condition, procedures performed and the products used. This document represents no promise or guarantee by Zimmer Biomet regarding coverage or payment for products or procedures by Medicare or other payers.

6 Providers should check Medicare bulletins, manuals, program memoranda, and Medicare guidelines to ensure compliance with Medicare requirements. Inquiries can be directed to the provider s respective Medicare Administrative Contractor, or to appropriate payers. Zimmer Biomet specifically disclaims liability or responsibility for the results or consequences of any actions taken in reliance on information in this