Orthopedic Coding Alert

Question: One of our orthopedic surgeons did a planned reimplantation of a total hip replacement (THR). But the removal of the THR and insertion of a cement spacer was previously done by a physician from another practice. We considered 27134 and 27130-22. Should we use conversion code 27132 instead?

Maryland Subscriber

Answer: For the scenario you describe, you may use 27132 (Conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft).

You’ll report a conversion to total hip (27132) when the patient has had a prior procedure, such as a hemiarthroplasty, and subsequently undergoes a total hip replacement.

When the physician performs a staged revision, you’ll also report 27132. During the first stage, the physician removes the implant and places a spacer (27091, Removal of hip prosthesis; complicated, including total hip prosthesis, methylmethacrylate with or without insertion of spacer), and during the second stage, the physician removes the spacer and performs a reimplantation of THR components (27132).

Note: If the surgeon fabricates an antibiotic spacer, then you should report 11981 (Insertion, non-biodegradable drug delivery implant) in addition to code 27091.

So if, as in your case, the surgeon performs a planned THR reimplantation, you may report 27132. The surgeon who performed the THR removal and spacer insertion will report 27091.

You may also report 27132 for a THR if a patient has had a prior hemiarthroplasty.

Fight the temptation to report a revision code such as 27134 (Revision of total hip arthroplasty; both components, with or without autograft or allograft), which you should only use if one or both of the THR components fails and needs to be revised. And 27130-22 (Arthroplasty, acetabular and proximal femoral prosthetic replacement [total hip arthroplasty], with or without autograft or allograft; increased procedural services) is more appropriate for a complex primary total hip arthroplasty on a patient with a congenital or developmental hip dislocation.