Total knee arthroplasty (TKA), unilateral
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Total knee arthroplasty billed without adequate medical necessity documentation
Occasional27447 (total knee arthroplasty) requires severe knee pathology (advanced osteoarthritis, post-traumatic arthritis, failed prior surgeries) with failed conservative treatment. High-value procedure with strict criteria. Denied when conservative management not documented or when diagnosis insufficient for replacement.
Common Causes
- • No documentation of failed conservative treatment (PT, injections, bracing)
- • Mild-moderate arthritis without bone-on-bone joint destruction
- • Recent diagnosis without adequate trial of non-surgical management
Resolution Strategy
Document medical necessity: 'Severe tricompartmental knee osteoarthritis with complete cartilage loss, bone-on-bone all compartments on radiographs. Conservative treatment failed: 12 months PT with strengthening, 4 viscosupplementation injections, unloader brace trial, maximum anti-inflammatories - persistent severe pain limiting ambulation. Total knee arthroplasty performed with cemented femoral/tibial components and patellar resurfacing.' Must document: severe pathology (imaging), comprehensive conservative treatment trial, functional limitation, components used.
💬 Plain Language Explanation
What this means
This is a total knee replacement surgery - a major surgery where your damaged knee joint is replaced with an artificial joint.
Why you might see this
This is a major surgical procedure. You might see this if you had severe knee arthritis or knee damage that required joint replacement surgery. This is one of the most common orthopedic surgeries.
Common context
Common major orthopedic surgery for severe knee arthritis or damage, usually done when other treatments haven't worked.
What to ask your provider
"'Why was knee replacement necessary? What type of artificial joint was used? What's my recovery timeline?'"
Relative Value Units (RVUs)
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Clinical Information
When to Use
For total replacement of knee joint with prosthetic components for end-stage osteoarthritis or other degenerative disease
Common Scenarios
Documentation Requirements
- Pre-operative diagnosis and indication
- Implant components used (brand/model)
- Operative technique and approach
- Complications or unusual findings
- Post-operative care plan
Coding Guidelines
Common Modifiers
Bundling Rules
- Includes all prosthetic components
- Includes bone cuts and preparation
- Anesthesia billed separately
Exclusions
- Revision knee uses different codes
- Unicompartmental knee uses 27446
- Bilateral knee uses modifier 50
Coding Notes
Clinical scenarios
- Pre-operative diagnosis and indication
- Implant components used (brand/model)
- Operative technique and approach
- Pre-operative diagnosis and indication
- Implant components used (brand/model)
- Operative technique and approach
- Pre-operative diagnosis and indication
- Implant components used (brand/model)
- Operative technique and approach
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Code Details
Medicare Pricing
PFSRVU Breakdown
OPPS Details
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Ask a QuestionFrequently Asked Questions
CPT 27447 is the billing code for "Total knee arthroplasty (TKA), unilateral". For total replacement of knee joint with prosthetic components for end-stage osteoarthritis or other degenerative disease
Medicare pays approximately $1257.63 for CPT 27447 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.
CPT 27447 has a total RVU of 48.88, broken down as: Work RVU 22.02, Practice Expense RVU 24.77, and Malpractice RVU 2.09. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 27447 is "Total knee arthroplasty billed without adequate medical necessity documentation". 27447 (total knee arthroplasty) requires severe knee pathology (advanced osteoarthritis, post-traumatic arthritis, failed prior surgeries) with failed conservative treatment. High-value procedure with strict criteria. Denied when conservative management not documented or when diagnosis insufficient for replacement. Common causes include: No documentation of failed conservative treatment (PT, injections, bracing); Mild-moderate arthritis without bone-on-bone joint destruction. Appeal success rate is approximately 40-60%.
Key documentation requirements for CPT 27447 include: Pre-operative diagnosis and indication; Implant components used (brand/model); Operative technique and approach; Complications or unusual findings. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 27447: Includes all prosthetic components. Includes bone cuts and preparation Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 27447 include: 22 (Increased procedural complexity), 50 (Bilateral procedure (both knees)), 51 (Multiple procedures). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 27447 is 120-150 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.