Wiki Girdlestone Procedure (27122) vs Prosthesis removal (27091)

[stacy]

Can someone please explain the difference between these two codes. Does anyone have any supportive information when to use code 27122 vs 27091. Thank you

 

[nickelclaw]

Hello below are the coder's desk reference by Optum description of the two procedures:
27122

The physician incises the hip joint capsule to expose the femoral head, neck, and acetabular rim. These components are removed. The physician uses a curette to remove any remaining necrotic or infected bone. The physician drains any intrapelvic abscesses. Drains are inserted. The incision is repaired in layers with sutures, staples, and/or Steri-strips. The hip is immobilized in a cast or with traction.

27091

The patient is placed in a lateral decubitus position (lying on the side). The physician may access the prosthesis through the previous hip surgery incision. Any scar tissue is resected. The physician exposes and incises the hip joint capsule. The hip is manually dislocated. Methylmethacrylate (cement) is removed from the upper portion of the stem. The physician removes the stem with forceful blows. The physician removes any cement. The physician may make a bone window in the femoral cortex to remove additional cement. If there is bony ingrowth, flexible osteotomes may be used to remove the bone, allowing further stem retraction. The physician removes cement from the border of the implant with chisels and gouges. The physician removes the acetabular components with instruments. Any remaining loose cement is removed with a large curette or other instrument. A spacer of methylmethacrylate formed into a cube shape may be inserted into the space between the femur and tibia. The spacer prevents the soft tissues from compressing the joint space. The spacer is secured until another prosthesis is inserted. Drains may be placed. The wound may be left open for healing or the incision is repaired in layers.

 

[stacy]

Thank you for the information. Any thoughts on THA removal due periprosthetic jt. infection, what would trump one code over the other to use? Prothesis is removed in both description of the codes. Provider is reporting to code Girdlestone Procedure but thinking 27091.

 

[amyjph]

Girdlestone is resection of the native femoral head, it doesn't say anything about a prosthesis already being in place. Usually done for osteomyelitis or osteonecrosis type problems among other things like fracture or OA, diseased femoral head, etc.

If the patient has a THA in place and periprosthetic joint infection and the prosthesis is removed with or without insertion of a spacer that's 27091. Then it is kept in place until the infection clears and they go back in for stage two & reinsertion of a new, final prosthesis. Sometimes I have seen where patients actually live with the spacer and don't go back or they keep having to get washouts and abx spacers.

 

[amyjph]

You may want to check CPT Assistant or AAOS. I just have never seen Girdlestone coded for a hip that has a prior THA in place, I have only seen it coded for a native femoral head.

27091 is removal of all the THA components head, stem, acetabular components.