# Hip Spacer Exchange help!



## purplescarf23 (Aug 11, 2011)

I need help with a hip spacer replacement.  Would I bill the hip revision or woud I bill the spacer replacement.  Please see below.  Thanks.  




PREOPERATIVE DIAGNOSIS(ES):  Periprosthetic infection, right hip;
right total hip arthroplasty.

POSTOPERATIVE DIAGNOSIS(ES):  Periprosthetic infection, right hip;
right total hip arthroplasty.

PROCEDURE(S) PERFORMED:  Irrigation, debridement, and liner and head
exchange.

SURGEON:  x

ASSISTANT:  x

ANESTHESIA:  General.

COMPLICATIONS:  None.

IMPLANT:  Polyethylene acetabular liner 36 mm neutral with a +4 offset
and a 36 mm +15.5 femoral head.

DRAINS:  2 Hemovac drains.

DISPOSITION:  PACU in satisfactory condition.

PROCEDURE:  After adequate general anesthesia was established, the
patient was carefully placed in left lateral decubitus position
supported by the pegboard system.  All bony prominences were padded,
axillary roll was used.  Prep was ChloraPrep.  The leg was draped
free.  Iodophor was used on all skin surfaces in a sandwich technique.
Old incision was opened.  There was obvious collection of purulent
material.  This was evacuated.  Pulse lavage fluid 4 L was used while
debridement was performed.  Bleeding points electrocoagulated as
encountered.  The fascia appeared intact.  Based on the aggressive
nature of the bacteria, decision was made after cleansing of the
superficial compartment to enter into the joint.  Upon entering though
there was obvious collection of cloudy fluid, this was sent for
culture.  The fibrinous exudate was removed.  Pulse lavage was again
used extensively on all surfaces.  Hip was dislocated and removed
without injury to the trunnion.  The plastic was removed without
incident.  The irrigation was aggressively performed around all
hardware.  A new liner was placed after completion of the irrigation
and debridement.  New head was placed, reduction was performed.
Sciatic nerve was explored and noted to be free throughout its course
except for a some encasement and scar posterior to the joint, there
was none involved with the cable.  The short external rotators
returned to the greater trochanter with #1 PDS, fascial lata closed
with #1 PDS, subcu with #1 PDS, and skin with 3-0 Prolene.  Two 1/4-
inch Hemovac drains were used, one from deep and one from superficial.
The ChloraPrep, Xeroform, and minimal taping with Medipore tape was
performed in view of the patient's skin fragility.  The patient was
placed on abduction wedge, awakened without incident and transferred
to gurney to PACU in satisfactory condition.  Sponge, needle, and
instrument count was correct at the end of the case.


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## DCoburn (Aug 11, 2011)

Please correct me if I am wrong.  However, after reviewing the documentation and components used in the procedure.  I would suggest reviewing CPT code 27134 (Revision total hip arthroplasty) with the use of modifier 52 (reduced services) due to the fact that part of the acetabular component was used; "the liner".


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## nyyankees (Aug 12, 2011)

DCoburn said:


> Please correct me if I am wrong.  However, after reviewing the documentation and components used in the procedure.  I would suggest reviewing CPT code 27134 (Revision total hip arthroplasty) with the use of modifier 52 (reduced services) due to the fact that part of the acetabular component was used; "the liner".



I agree....


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