How To Use CPT Code 27090

CPT 27090 describes the removal of a hip joint prosthesis as a separate procedure. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 27090?

CPT 27090 can be used to describe the surgical removal of a hip joint prosthesis as a separate procedure. This code is used when the provider needs to remove a loose or damaged prosthesis from the hip joint to prevent further harm to the joint. The procedure involves making an incision in the skin of the hip joint, dissecting down through the subcutaneous tissue, protecting the sciatic nerve, releasing the soft tissue, dislocating the femur prosthesis fixed in the acetabulum of the pelvis, and removing the implant. The wound is then irrigated with antibiotic solution and closed in layers.

2. Official Description

The official description of CPT code 27090 is: ‘Removal of hip prosthesis; (separate procedure)’

3. Procedure

1. The provider makes an incision in the skin of the hip joint.
2. They dissect down through the subcutaneous tissue to reach the hip joint capsule.
3. The provider identifies and protects the sciatic nerve and releases the soft tissue.
4. They dislocate the femur prosthesis fixed in the acetabulum of the pelvis.
5. If necessary, the provider may cut the top of the femur into several pieces to remove the implant.
6. The wound is irrigated with antibiotic solution.
7. The provider closes the wound in layers.
8. A drain may be left in place if required.

4. Qualifying circumstances

CPT 27090 is performed when there is a need to remove a hip joint prosthesis as a separate procedure. This may be necessary when the prosthesis becomes loose or damaged, causing pain or dysfunction in the joint. The procedure is typically performed as part of a revision arthroplasty of the hip joint. It is important to note that CPT 27090 cannot be reported separately with a related procedure when performed in an anatomically related region through the same skin incision.

5. When to use CPT code 27090

CPT code 27090 should be used when the provider performs the removal of a hip joint prosthesis as a separate procedure. It should not be reported with a related procedure performed in the same anatomical region through the same skin incision. If the provider performs CPT 27090 with an unrelated procedure, modifier 59 may need to be appended to indicate that it is a distinct procedural service.

6. Documentation requirements

To support a claim for CPT 27090, the provider must document the following information:

• Reason for the removal of the hip joint prosthesis
• Details of the procedure, including the incision, dissection, protection of nerves, dislocation of the prosthesis, and any additional steps taken
• Use of antibiotic solution for wound irrigation
• Closure of the wound in layers
• Any drains left in place

7. Billing guidelines

When billing for CPT 27090, ensure that the procedure is performed as a separate procedure and not as part of a related procedure in the same anatomical region through the same skin incision. If CPT 27090 is performed with an unrelated procedure, modifier 59 may need to be appended. It is important to review payer-specific guidelines and policies for accurate billing and reimbursement.

8. Historical information

CPT 27090 was added to the Current Procedural Terminology system on January 1, 1990. It was initially listed as a separate procedure. In 2017, it was added to the Inpatient Only (IPO) list for Medicare. However, in 2021, it was removed from the IPO list. In 2022, it was added back to the IPO list for Medicare.

9. Examples

1. A provider performs CPT 27090 to remove a loose hip joint prosthesis in a patient with severe pain and dysfunction in the joint.
2. During a revision arthroplasty of the hip joint, the provider determines that the femur prosthesis needs to be replaced. They perform CPT 27090 to remove the existing prosthesis before inserting a new one.
3. A patient presents with a damaged hip joint prosthesis that is causing recurrent infections. The provider performs CPT 27090 to remove the prosthesis and address the infection.
4. After a traumatic injury to the hip joint, the provider determines that the hip joint prosthesis needs to be removed. They perform CPT 27090 to remove the prosthesis and assess the extent of the injury.
5. A patient with a history of hip joint arthroplasty experiences dislocation of the femur prosthesis. The provider performs CPT 27090 to relocate the prosthesis and ensure proper alignment.
6. During a routine follow-up visit, the provider discovers that the hip joint prosthesis has become loose. They perform CPT 27090 to remove the prosthesis and prevent further damage to the joint.
7. A patient with a hip joint prosthesis develops an allergic reaction to the implant material. The provider performs CPT 27090 to remove the prosthesis and address the allergic reaction.
8. After a thorough evaluation, the provider determines that the hip joint prosthesis is causing instability in the joint. They perform CPT 27090 to remove the prosthesis and restore stability.