How To Use CPT Code 27091

CPT 27091 describes the removal of a hip prosthesis, including a total hip prosthesis, with or without the insertion of a spacer. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 27091?

CPT 27091 involves the surgical removal of a hip prosthesis, which may include a total hip prosthesis, along with the potential insertion of a spacer. This procedure is performed to address complications or damage to the prosthesis and prevent further harm to the joint. It is important to note that CPT 27091 is typically performed as part of a larger procedure, such as the revision of total hip arthroplasty.

2. Official Description

The official description of CPT code 27091 is the “Removal of hip prosthesis; complicated, including total hip prosthesis, methylmethacrylate with or without insertion of spacer.” This code specifically covers the removal of a hip prosthesis, which may involve breaking the methylmethacrylate cement used to secure the prosthesis and potentially placing a spacer in the vacant space.

3. Procedure

1. During the procedure, the provider begins by making an incision in the skin of the hip joint and dissecting through the subcutaneous tissue to reach the hip joint capsule.
2. Next, the provider identifies and protects the sciatic nerve and releases the soft tissue surrounding the joint.
3. The provider then breaks the methylmethacrylate cement to dislocate the femur prosthesis fixed in the acetabulum of the pelvis.
4. Using surgical instruments, the provider removes the cement from the border of the implant and proceeds to remove the acetabular component of the prosthesis.
5. If necessary, the provider uses a curette to remove any excess cement in the socket and may insert a spacer between the femur and acetabular socket to prevent shortening of the extremity.
6. Finally, the provider irrigates the wound with an antibiotic solution and closes the wound in layers, potentially leaving a drain in place if required.

4. Qualifying circumstances

CPT 27091 is performed in cases where there is a need to remove a loose or damaged hip prosthesis. The procedure is typically indicated when irreversible harm to the joint can be prevented by removing the prosthesis. It is important to note that this code is used for complicated cases and may involve the removal of a total hip prosthesis, along with the use of methylmethacrylate cement and potential insertion of a spacer.

5. When to use CPT code 27091

CPT code 27091 should be used when a provider performs the removal of a hip prosthesis, including a total hip prosthesis, with or without the insertion of a spacer. It is important to note that this code is typically used as part of a larger procedure, such as the revision of total hip arthroplasty. It should not be reported separately if performed as part of a comprehensive hip revision procedure.

6. Documentation requirements

To support a claim for CPT code 27091, the provider must document the following information:

• Patient’s diagnosis and the need for prosthesis removal
• Details of the procedure, including the use of methylmethacrylate cement and insertion of a spacer, if applicable
• Date of the procedure
• Any additional procedures performed during the same operative session
• Any complications encountered during the procedure
• Post-operative care instructions, including any prescribed medications or follow-up appointments

7. Billing guidelines

When billing for CPT code 27091, it is important to ensure that the procedure meets the criteria for a complicated removal of a hip prosthesis, including a total hip prosthesis, with or without the insertion of a spacer. It is also crucial to consider the appropriate use of modifiers and any applicable bundling or unbundling rules. Additionally, it is important to note that CPT code 27091 is typically reported as part of a larger procedure, such as the revision of total hip arthroplasty.

8. Historical information

CPT code 27091 was added to the Current Procedural Terminology system on January 1, 1990. Over the years, there have been changes in its status, including being added to the Inpatient Only (IPO) list in 2017 and subsequently removed from the IPO list in 2021. It is important to stay updated with the latest coding guidelines and payer requirements regarding the use of CPT code 27091.

9. Examples

1. A patient undergoes the removal of a hip prosthesis, including a total hip prosthesis, with the insertion of a spacer due to complications.
2. A provider performs the removal of a hip prosthesis, including a total hip prosthesis, without the insertion of a spacer, to address a loose implant.
3. During a revision arthroplasty procedure, the provider removes a damaged hip prosthesis, including a total hip prosthesis, and replaces it with a new prosthesis.
4. A patient with a history of hip surgery undergoes the removal of a hip prosthesis, including a total hip prosthesis, with the insertion of a spacer to prevent shortening of the extremity.
5. A provider performs the removal of a hip prosthesis, including a total hip prosthesis, due to an infection at the implant site.
6. During a complex hip revision procedure, the provider removes a hip prosthesis, including a total hip prosthesis, and addresses bone loss with the insertion of a spacer.