Orthopedic Coding Alert

Question: When doing a revision of a total joint arthroplasty, what code is used if: Only the acetabular liner is changed but the entire femoral component? The entire acetabular component is revised but only the femoral head? The femoral head and acetabular liner only? The codes available are 27134 (revision total hip arthroplasty), 27137 (revision of acetabular component only) or 27138 (revision of femoral component).

Is any revision to a component considered revision of the entire component? If part of each component is revised, such as femoral head and acetabular liner, is it a revision THA (total hip arthroplasty)? For a revision of knee arthroplasty, what code is used for exchange of tibial liner if tibial and femoral components are not revised?

Gayle Krupin
Detroit, Mich.

Answer: Consider the documentation on a case-by-case basis for each of these questions. If the revision of one component also includes replacing the liner of the other, ask whether documentation supports a significant level of additional work. If so, consider appending modifier -22 (unusual procedural services) to the code for the revision of the one component and submitting with the operative report. In many cases, there is no documentation to support this scenario, so you would bill just the revision of the one component alone. If there are procedures where just the liners are changed, pick the code for the component involved and submit with modifier -52 (reduced services) and a copy of the operative report.