How To Use CPT Code 27130

CPT 27130 is a surgical procedure code for total hip arthroplasty with or without autograft or allograft. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 27130 procedures.

1. What is CPT 27130?

CPT 27130 is a code used to describe the surgical procedure of total hip arthroplasty, which involves the replacement of the hip joint with a prosthetic implant. This procedure is performed to relieve pain and improve function in patients with hip arthritis who have not responded to conservative treatment options.

2. 27130 CPT code description

The official description of CPT code 27130 is: “Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft.”

3. Procedure

The 27130 procedure involves the following steps:

  1. The patient is appropriately prepped and anesthetized.
  2. An incision is made in the skin of the hip joint, and the provider dissects down through the subcutaneous tissue to reach the hip joint capsule.
  3. The sciatic nerve is identified and protected, and the soft tissue is released.
  4. The hip joint is manually dislocated, and the femoral component is separated from the acetabulum.
  5. The femoral head is removed from the end of the femur using a saw.
  6. A reamer is used in the acetabulum to create a perfect hemispherical bone socket that matches the shape of the acetabular prosthesis.
  7. The acetabular prosthetic component is placed in the socket and secured using bone cement and possibly a graft.
  8. The femoral shaft canal is prepared using a reamer or rasp for inserting the femoral prosthetic component.
  9. The femoral prosthetic stem is inserted into the femoral shaft and affixed using bone cement.
  10. The two components are reunited using a graft, if appropriate, and cement, and the hip joint is reduced, restoring the normal alignment of the hip joint.
  11. The wound is irrigated with antibiotic solution and closed in layers. A drain may be left in place if required.

4. Qualifying circumstances

Patients eligible to receive CPT code 27130 services are those with hip arthritis who have not responded to conservative treatment options, such as medication, physical therapy, or activity modification. The patient’s pain and functional limitations must be severe enough to warrant surgical intervention, and they should be in good overall health to minimize the risk of complications during and after the procedure.

5. When to use CPT code 27130

It is appropriate to bill the 27130 CPT code when a provider performs a total hip arthroplasty with or without autograft or allograft for a patient with hip arthritis who has not responded to conservative treatment options. The procedure should be medically necessary and supported by appropriate documentation.

6. Documentation requirements

To support a claim for CPT 27130, the following information should be documented:

  • Patient’s medical history, including conservative treatments tried and their outcomes
  • Physical examination findings, including range of motion, strength, and joint stability
  • Radiographic evidence of hip arthritis
  • Indications for surgery, such as pain, functional limitations, and impact on the patient’s quality of life
  • Details of the surgical procedure, including the type of implant used, any grafts, and the use of bone cement
  • Postoperative care plan, including pain management, physical therapy, and follow-up appointments

7. Billing guidelines

When billing for CPT code 27130, it is essential to ensure that the procedure is medically necessary and supported by appropriate documentation. Additionally, the provider should be aware of any specific payer requirements, such as prior authorization or the use of specific modifiers. It is also important to be familiar with any relevant coding guidelines, such as the use of separate codes for related procedures or the use of modifiers to indicate bilateral procedures.

8. Historical information

CPT 27130 was added to the Current Procedural Terminology system in 1990. The code descriptor was changed on January 1, 2002, from “Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip replacement), with or without autograft or allograft” to its current description. In 2017, CPT 27130 was added to the Medicare Inpatient Only (IPO) list, and in 2020, it was removed from the IPO list.

9. Similar codes to CPT 27130

Five similar codes to CPT 27130 and how they differentiate are:

  • CPT 27132: Used when the provider performs total hip arthroplasty with or without an autograft or allograft in a hip that has undergone previous surgery.
  • CPT 27134: Used when the provider performs revision arthroplasty of the hip by replacing both femoral and acetabular components.
  • CPT 27137: Used when the provider performs revision arthroplasty of the hip by replacing only the acetabular component with or without an autograft or allograft.
  • CPT 27138: Used when the provider performs revision arthroplasty of the hip by replacing only the femoral component with or without an autograft or allograft.
  • CPT 27236: Used when the provider performs open treatment of a femoral fracture with internal fixation and total hip arthroplasty.

10. Examples

Here are 10 detailed examples of CPT code 27130 procedures:

  1. A 65-year-old patient with severe osteoarthritis of the left hip undergoes total hip arthroplasty using a cemented acetabular and femoral component.
  2. A 58-year-old patient with rheumatoid arthritis and significant hip joint destruction undergoes total hip arthroplasty with a cementless acetabular component and a cemented femoral component.
  3. A 70-year-old patient with advanced osteoarthritis of the right hip undergoes total hip arthroplasty using a cementless acetabular and femoral component and an autograft.
  4. A 62-year-old patient with post-traumatic arthritis of the left hip undergoes total hip arthroplasty using a cemented acetabular component and a cementless femoral component.
  5. A 55-year-old patient with avascular necrosis of the right femoral head undergoes total hip arthroplasty using a cementless acetabular and femoral component.
  6. A 67-year-old patient with severe osteoarthritis of the left hip undergoes total hip arthroplasty using a cemented acetabular component, a cementless femoral component, and an allograft.
  7. A 72-year-old patient with advanced osteoarthritis of the right hip undergoes total hip arthroplasty using a cementless acetabular component, a cemented femoral component, and an autograft.
  8. A 60-year-old patient with post-traumatic arthritis of the left hip undergoes total hip arthroplasty using a cemented acetabular and femoral component and an allograft.
  9. A 68-year-old patient with severe osteoarthritis of the right hip undergoes total hip arthroplasty using a cementless acetabular component, a cemented femoral component, and an autograft.
  10. A 63-year-old patient with advanced osteoarthritis of the left hip undergoes total hip arthroplasty using a cemented acetabular and femoral component and an allograft.

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