How To Use CPT Code 27125

CPT 27125 describes a specific procedure for repair, revision, and/or reconstruction of the pelvis and hip joint. This article will provide an overview of CPT code 27125, including its official description, the procedure involved, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 27125?

CPT 27125 is a code used to describe a particular procedure for repair, revision, and/or reconstruction of the pelvis and hip joint. This code is specifically for a hemiarthroplasty of the hip, which involves the removal of a damaged head of the femur and its replacement with a prosthetic device. It is important to note that this procedure does not involve the replacement of the acetabulum, which is the cup-shaped socket of the hip bone.

2. Official Description

The official description of CPT code 27125 is: ‘Hemiarthroplasty, hip, partial (e.g., femoral stem prosthesis, bipolar arthroplasty).’ It is important to note that if the procedure is being performed as a prosthetic replacement following a hip fracture, a different CPT code, 27236, should be used.

3. Procedure

1. The provider begins by making an incision over the posterior aspect of the hip, after the patient has been appropriately prepped and anesthetized.
2. Next, the provider carefully dissects all the muscles around the hip joint to expose the joint capsule.
3. The provider then dissects the joint capsule to gain access to the femoral head and neck.
4. The damaged femoral head and neck are excised from the bone.
5. A prosthetic device, such as a femoral stem prosthesis, is then inserted into the femoral canal.
6. In some cases, bone cement may be used to secure the prosthesis in the correct position.
7. After the prosthesis is in place, the provider evaluates the stability and mobility of the joint.
8. The joint capsule is closed, and the site is flushed with sterile saline solution to ensure cleanliness.
9. The provider ensures hemostasis and closes the incision with sutures in layers.

4. Qualifying circumstances

CPT 27125 is typically performed on patients who require a hemiarthroplasty of the hip. This procedure is often indicated for patients with hip joint damage or degenerative conditions that affect the femoral head. It is important to note that this procedure does not involve the replacement of the acetabulum. The provider must carefully assess the patient’s condition and determine the need for a hemiarthroplasty. The procedure should be performed by a qualified healthcare professional with expertise in hip joint surgeries.

5. When to use CPT code 27125

CPT code 27125 should be used when a provider performs a hemiarthroplasty of the hip, which involves the partial replacement of the hip joint. This code should not be used for procedures that involve the complete replacement of both the femoral and acetabular components of the hip joint. It is important to accurately document the specific procedure performed to ensure proper coding and billing.

6. Documentation requirements

When reporting CPT code 27125, the provider must document the following information:

• Patient’s diagnosis and the need for a hemiarthroplasty
• Details of the procedure performed, including the specific prosthetic device used
• Date of the procedure
• Start and end time of the procedure
• Any additional procedures or interventions performed during the same session
• Any complications or unexpected findings
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 27125, it is important to ensure that the procedure performed aligns with the specific requirements of the code. The provider should be familiar with the guidelines and documentation requirements for accurate billing. It is also important to note that CPT code 27125 should not be reported with other codes that involve different procedures or components of the hip joint. Proper coding and billing practices will help ensure appropriate reimbursement for the services provided.

8. Historical information

CPT code 27125 was added to the Current Procedural Terminology system on January 1, 1990. Since its addition, there have been several historical changes related to Medicare coverage and reimbursement. For example, it was initially added to the Inpatient Only (IPO) list in 2017 but was later removed in 2021. However, in 2022, it was added back to the IPO list. Providers should stay updated on any changes in coverage and reimbursement policies related to CPT code 27125.

9. Examples

1. A patient with severe hip joint degeneration undergoes a hemiarthroplasty of the hip to replace the damaged femoral head with a prosthetic device.
2. Following a hip fracture, a patient requires a hemiarthroplasty to stabilize the joint and restore function.
3. A patient with a history of hip joint infection undergoes a hemiarthroplasty to remove the infected tissue and replace it with a prosthetic device.
4. An elderly patient with osteoarthritis of the hip undergoes a hemiarthroplasty to alleviate pain and improve mobility.
5. A patient with avascular necrosis of the femoral head undergoes a hemiarthroplasty to replace the necrotic tissue and restore joint function.
6. A patient with a failed previous hip surgery undergoes a hemiarthroplasty to revise the femoral component and improve joint stability.