How To Use CPT Code 27134

CPT 27134 describes the procedure for the revision of total hip arthroplasty, involving the replacement of both components of the hip joint with or without the use of autograft or allograft. This article will provide an overview of CPT code 27134, including its official description, the procedure involved, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples.

1. What is CPT Code 27134?

CPT 27134 is used to describe the revision of total hip arthroplasty, which involves the removal of a previously implanted artificial hip joint or prosthesis and the replacement of both the femoral and acetabular components. This procedure may or may not involve the use of autograft or allograft. It is performed to address issues such as a loose or damaged prosthesis that could cause irreversible harm to the joint.

2. Official Description

The official description of CPT code 27134 is: ‘Revision of total hip arthroplasty; both components, with or without autograft or allograft.’

3. Procedure

1. 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. They identify and protect the sciatic nerve and release 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, they remove the cement from the border of the implant and proceed to remove the femoral stem from the femoral shaft.
5. The acetabular component of the prosthesis is also removed, and any excess cement in the socket is cleared using a curette.
6. If necessary, a new acetabular component is placed and secured with bone cement and graft tissue.
7. The provider then inserts the new femoral prosthesis or stem into the femoral shaft and fixes it in place using bone cement.
8. If required, the two components are reunited using a graft and cement, restoring the normal alignment of the hip joint.
9. The wound is irrigated with antibiotic solution, and the provider closes the incision in layers, potentially leaving a drain in place.

4. Qualifying circumstances

CPT 27134 is performed on patients who require a revision of their total hip arthroplasty. This may be due to a loose or damaged prosthesis that poses a risk to the joint. The procedure can involve the use of autograft or allograft, which are tissues transferred from one part of the body or from another individual of the same species, respectively.

5. When to use CPT code 27134

CPT code 27134 should be used when a provider performs the revision of total hip arthroplasty, replacing both the femoral and acetabular components. It is important to note that this code is not appropriate for cases where only one component is being revised. In such instances, specific codes, such as CPT 27137 for acetabular component revision or CPT 27138 for femoral component revision, should be used instead.

6. Documentation requirements

To support a claim for CPT 27134, the provider must document the following information:

• The need for revision of total hip arthroplasty
• Details of the procedure, including the use of autograft or allograft
• Date of the procedure
• Start and end time of the procedure
• Any additional procedures performed during the revision
• Any complications encountered and their management
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 27134, it is important to ensure that the procedure involves the revision of both components of the hip joint. The use of autograft or allograft should also be documented if applicable. Additionally, it is crucial to follow any specific guidelines provided by payers regarding the reporting of this code. It is also important to note that CPT 27134 should not be reported with other codes that describe similar procedures, such as CPT codes 27137 and 27138.

8. Historical information

CPT code 27134 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 or removed from the Inpatient Only (IPO) list for Medicare. It is important to stay updated with the latest guidelines and regulations regarding the use of this code.

9. Examples

1. A provider performs a revision of total hip arthroplasty, replacing both the femoral and acetabular components, for a patient with a loose prosthesis.
2. During a revision surgery, a provider replaces both the femoral and acetabular components of a patient’s hip joint, using autograft to address bone loss.
3. A patient undergoes a revision of total hip arthroplasty, with the provider replacing both components and using allograft to enhance stability.
4. A provider performs a revision surgery, replacing both the femoral and acetabular components of a patient’s hip joint due to a damaged prosthesis.
5. During a revision procedure, a provider replaces both components of a patient’s hip joint and uses autograft to address bone defects.