Orthopedic Coding Alert

Question: The surgeon removed an infected spacer and inserted a new spacer at the same encounter. She had inserted the original spacer after removing an infected hip prosthesis two weeks earlier. How should we code these procedures? Texas Subscriber Answer: You should report the initial hip prosthesis removal and spacer insertion with 27091 (Removal of hip prosthesis; complicated, including total hip prosthesis, methylmethacrylate with or without insertion of spacer). Note that the descriptor includes "with or without insertion of spacer," so you should not bill the spacer insertion separately. The second procedure doesn't have a designated code in CPT. Consequently, you should report 27299 (Unlisted procedure, pelvis or hip joint). Don't forget: Typically, the surgeon performs the second procedure several months after the first. But if the surgeon performs the second procedure within the 90-day global period, append modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) to 27299 because this procedure is related to the original spacer insertion.