# Total Hip CPT Help



## djreiff (Feb 7, 2018)

We have a patient who is being scheduled for surgery and we're trying to figure out a code so we can obtain authorization with insurance. The patient is going to be having a total hip arthroplasty (THA) and removal of a deep screw that was used for fixation of a previous hip fracture. My physician thinks we should bill 27130 for the THA with 20680 for hardware removal.

My gut is telling me that there is a more specific code for the two being performed together. I could've sworn I saw a code for this type of situation before but cannot remember exactly where.

I can only seem to find 27132 for "Conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft "

Does anyone have any ideas or help? 

Thank you!


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## hblakeman (Feb 7, 2018)

*27132*

I would use 27132 in this situation.


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## Orthocoderpgu (Feb 7, 2018)

*20680 can't be billed*

If you read the CMS Ortho surgical policy manual it tells you that if hardware needs to be removed in order to perform a procedure, then the removal of the hardware is included in the procedure and not reported separately.


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## sxcoder1 (Feb 8, 2018)

I would use 27132 as well.  See the below information I found in another thread.

Ask Margie: Correct use of hip conversion code 27132: What the AMA says
 Published Nov 7, 2008
 Question: What is the intent of the hip conversion code 27132, especially in regard to "previous hip surgery?" Also, is there a time frame, and if so, does it include removal of old hardware? Could the code apply to a patient that as a child had hip dysplasia treated with a Pavlik harness, who now presents as an adult for total hip replacement (THR)? Could it apply to a patient that as a teenager dislocated his hip in a football game, had a reduction and now as an adult presents for a THR? Or could it apply to a patient that had a hip arthroscopy at a younger or older age, and now years later presents for THR? Or for a patient that had a previous hip pinning, plating, screws, etc., and now presents for a THR?

 Answer: I recently sent the above series of questions to the AMA's CPT panel to get a clearer picture about the correct use of code 27132 (conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft).

 The AMA had the following answers, in consultation with the American Academy of Orthopaedic Surgeons and the American Orthopaedic Association:

 Intent of 27132 in regard to previous surgery: "Previous surgery results in scarring, deformity and an altered surgical field, making the procedure more difficult with potentially higher complication rates. It covers ANY previous surgery at any previous time where a skin incision was made."

 Time frame and removal of old hardware: "There is no time frame associated with code 27132, conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft. Code 27132 includes removal of old hardware."

 When a previous hip dysplasia was treated with a Pavlik harness: "A harness is not surgery, so use of code 27132 would not be appropriate in this instance. However, should the infant have undergone surgery, then code 27132 would be applicable."

 For a teenager who dislocated hip in football game, then presents as an adult for THR: "If a closed reduction of the hip dislocation was performed, then code 27132 would not be appropriate in this instance. However, if an open hip reduction had been performed, then code 27132 would be applicable."

 A patient that had hip arthroscopy and years later presents for THR: "In this specific circumstance, yes code 27132 would be applicable."

 A patient that had a previous hip pinning, plating, screws, etc., and now presents for a THR: "In this specific circumstance, yes code 27132 would be applicable."


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