Wiki Removal and replacement of antibiotic hip spacer.

[adunlap23]

The patient had the first stage of a two-stage THA revision performed. The original hip prosthesis was removed and an anitbiotic hip spacer was placed.

Now, the patient has returned due to dislocation of the hip spacer. The surgeon reports that the original spacer did not fit the patient well, and he replaced it with a better fitting spacer. How would I code revision of a hip spacer?

 

[amyjph]

Look at the code range 27000-20705 and all the parentheticals along with the information preceding that range. Your answer is in there.

 

[adunlap23]

Hello,

This is for a preauthorization code, so there is no op report...

I read that we are to use 20680 if no primary procedure is associated with the add-on code. That wouldn't cover the insertion of the new spacer, though. I thought about using 20680 for removal of the antibiotic spacer with add-on code 20704-manual preparation and insertion of drug-delivery device, intra-articular. However, 20680 is not listed as one of the codes we are supposed to use in conjunction with 20704.

I also thought about using 27033 with 20704, but 27033 isn't listed as a conjunction code either.

The rest of the codes seem to involve infection or involvement with the actual hip prosthesis. The reason for this procedure is for dislocation of the antibiotic spacer, and no prosthesis is being removed or inserted at this point.

 

[amyjph]

Oh gotcha. Not planning on anything else? Is it still infected though? Hard without seeing the note.
It's almost like 27091 but not as complicated. Or even like 27030 or 27033.
If you look at the excludes info for 20705, it directs us to other codes for removal of prosthesis following failed placement of drug delivery devices.
Agree, you can't do 20680 and 20704 together either.
It's a conundrum.
I would probably do an arthrotomy and then the insertion or maybe 27091-52. Depends on op note when it is done. If it is still infected you could do 27030 & 20704.