Wiki THR vs Conversion vs Revision

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knedley

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I have an on going debate with coding a THR/Conversion/Revision. Here is my questions.

A patient had a THR (27130), lets say 1 year ago.
This total hip became infected and the patient was taken to the OR to have the hip prothesis removed and an antiobiotic spacer put in. (27130)
The infection clears and 3 month later is returned to the OR for the spacer removal and THR. (27130. 11982)

Here is my question;
The physician wants me to code a Revision (27134), which I believe is only coded when the prosthesis is removed and replace in the same day.

or

A conversion (27132) because he is stating he is removing a spacer, which is a previous hip surgery for a total hip. This too I believe is incorrect because the guidelines that I read for this code is there can not be previous THR. According to what I have from the AMA is a surgery resulting from scarring, deformity and altered surgical field, makeing the procedure more difficult with potentially higher complication rates. Am I understanding correctly that this does NOT cover a previous THR?

Any guidance with this would be greatful. Any references would also be appreciated.

Thank you,
Kim
 
I think this AAOS post will help:

http://www.aaos.org/news/aaosnow/feb13/managing7.asp

Specifically this:

A conversion occurs when the patient has had prior open surgery with or without retained hardware (eg, plates, screws, dynamic hip screws, antibiotic spacers) that are removed and replaced with arthroplasty components. For example, the surgeon removes an infected hip prosthesis from a patient who had a total hip arthroplasty 2 years ago and places an antibiotic-impregnated cement spacer. The surgeon reports the following CPT codes:

•27091 (removal of hip prosthesis; complicated, including total hip prosthesis, methylmethacrylate with or without insertion of spacer)
•11981-51 (insertion, non-biodegradable drug delivery implant)

Six weeks later, the surgeon returns the patient to the surgical suite for a conversion to total hip arthroplasty. The surgeon reports the following CPT codes:

•27132-58 (conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft)
•11982-58, 51 (Removal, non-biodegradable drug delivery implant
 
Conversion THR, vs Revision

I disagree with the previous response. Conversion from prior hip surgery to THR does not include conversion from a prior THR to another, following the removal of a prosthesis for infection, or any other reason. It is not the intention of the code! Conversion is intended to be used for hips which at some point in the past, had internal fixation, osteotomy, or partial hip replacement, such as 27236. It should not be used when the patient requires a new total hip to be implanted, for whatever the reason may be. Revision should be reported for that. Revision of THR can take place at any time after the prior THR has been removed, not just during the same operative session as the removal. Often, the infected prosthesis is removed, an antibiotic spacer may be implanted, and the replacement of the THR is performed after the infection has been abolished, or sufficiently controlled that it is safe to redo. You must use revision both components for this! So the surgeon in this case was correct.
 
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