Orthopedic Coding Alert

Question: Our surgeon made a diagnosis of 'failed left total hip arthroplasty with aseptic loosening'. The operative note reads as follows:

"Attention was then turned to the acetabulum.  Circumferential exposure of the acetabulum was obtained. The previously identified loose acetabular shell appeared stable, however, there was marked polyethylene wear and poor and extensive osteolysis with delamination of the polyethylene.  The prior polyethylene was removed from the acetabular liner. The acetabulum was irrigated with Betadine, peroxide and pulsatile lavage.  The available polyethylene liners for this cup are not cross-linked.  At this time, the polyethylene liner was brought onto the field.  The backside of it was burred with a bur to allow for cement interdigitation.  At this time one pack of Simple P cement containing tobramycin and methylene blue was used to cement the acetabular liner into place. Excess cement was removed."

Does the procedure imply an acetabulum revision? Can we report 27138 (Revision of total hip arthroplasty; femoral component only, with or without allograft)? Will 27134 (Revision of total hip arthroplasty; both components, with or without autograft or allograft) be an appropriate code?

Alaska Subscriber

Answer: You should report code 27137 (Revision of total hip arthroplasty; acetabular component only, with or without autograft or allograft) -- 52 (Reduced services) as your surgeon is revising only the acetabular liner and not the cup. There is no indication that the femoral implant was revised in any way.