# explant hip hemiarthroplasty w/ implant of spacer.



## scooter1 (May 9, 2017)

Patient had a hemiarthroplasty ( for a fracture). She now has an infection and surgeon removes the implant, debrides, and places a antibiotic spacer. 
With a total I would code 27091, and 11981,  but this is a hemiarthroplasty.
Would I code 27091-52 and 11981 ? Or would it still be the 27091 without the 52 ?  I need some help with this one. Please . . . . .


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## AlanPechacek (May 10, 2017)

One big and important issue is whether the femoral head prosthesis was cemented in place.  The original procedure was the open treatment of a femoral neck fracture, not a hemiarthroplasty.  If not, then the second procedure would be 27090, Removal of a Hip Prosthesis, i.e. uncomplicated, but with the Debridement of the infection and placement of the antibiotic spacer, would probably qualify for a Modifier 22 for Increased Procedural Services, plus the 11981.  If the prosthesis had been cemented in place, as is usually done currently, then I would go with 27091 as the cement removal would make it "complicated," and although the descriptor "includes" total hip arthroplasty, it does not appear to "exclude" femoral head prosthesis removal.  This code alone would, in a sense, include the Modifier 22, and/but I wouldn't think that the Modifier 52 would be necessary.  The 11981 would still apply.

I hope this helps.

Respectfully submitted, Alan Pechacek, M.D.
icd10orthocoder.com


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## scooter1 (May 12, 2017)

thank you for your help. Much appreciated


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