How To Use CPT Code 27138

CPT 27138 describes the revision of a total hip arthroplasty, specifically the femoral component, with or without the use of an allograft. This article will provide an overview of the code, including its official description, the procedure involved, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and similar codes to CPT 27138.

1. What is CPT Code 27138?

CPT 27138 is used to describe the revision of a total hip arthroplasty, specifically focusing on the femoral component. This procedure involves the removal of a previously implanted artificial hip joint or prosthesis and replacing it with a new prosthesis. The provider may or may not use an allograft during the revision surgery.

2. Official Description

The official description of CPT code 27138 is: ‘Revision of total hip arthroplasty; femoral component only, with or without allograft.’

3. Procedure

1. The provider begins by making an incision in the skin of the hip joint and dissecting down 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 a surgical instrument, they remove the cement from the border of the implant and remove the femoral stem from the femoral shaft.
5. The new femoral prosthesis or stem is inserted into the femoral shaft and fixed in place using bone cement.
6. If necessary, the provider may use a graft to reunite the two components and restore the normal alignment of the hip joint.
7. The wound is irrigated with antibiotic solution, and the provider closes the wound in layers, potentially leaving a drain in place if required.

4. Qualifying circumstances

CPT 27138 is performed when there is a need to remove and replace the femoral component of a previously implanted artificial hip joint. The procedure may involve the use of an allograft, which is a tissue transferred from one individual of the same species to another. It is important to note that this code specifically focuses on the femoral component and does not include the acetabular component.

5. When to use CPT code 27138

CPT code 27138 should be used when the provider performs a revision of a total hip arthroplasty, specifically replacing the femoral component. It is important to ensure that the documentation supports the need for the revision and specifies the use of an allograft if applicable.

6. Documentation requirements

To support a claim for CPT code 27138, the provider must document the following information:

• Reason for the revision and the need to replace the femoral component
• Use of an allograft, if applicable
• Date of the procedure
• Details of the surgical approach and technique
• Any additional procedures performed during the revision
• Any complications or unexpected findings
• Post-operative care instructions

7. Billing guidelines

When billing for CPT code 27138, it is important to ensure that the documentation supports the need for the revision and specifies the replacement of the femoral component. This code should not be reported with other codes that include the acetabular component. It is also important to follow any specific billing guidelines provided by the payer or Medicare.

8. Historical information

CPT code 27138 was added to the Current Procedural Terminology system on January 1, 1990. It was initially listed as an inpatient-only (IPO) procedure, but it was later removed from the IPO list in 2021. However, in 2022, it was added back to the IPO list.

9. Examples

1. A patient undergoes a revision of a total hip arthroplasty, specifically replacing the femoral component, due to loosening and instability.
2. A provider performs a revision of a total hip arthroplasty, replacing the femoral component, with the use of an allograft to address bone loss.
3. During a revision surgery, the femoral component of a previously implanted artificial hip joint is replaced due to infection.
4. A patient with a history of hip arthroplasty undergoes a revision procedure to replace the femoral component, which has worn out over time.
5. A provider performs a revision of a total hip arthroplasty, replacing the femoral component, to address recurrent dislocations.
6. Due to a fracture around the femoral component, a patient undergoes a revision of a total hip arthroplasty to replace the femoral component.
7. A patient with a failed femoral component of a total hip arthroplasty undergoes a revision surgery to replace the component and restore function.
8. During a revision procedure, the provider replaces the femoral component of a total hip arthroplasty to address pain and instability.
9. A patient with a history of hip arthroplasty undergoes a revision surgery to replace the femoral component, which has become loose over time.
10. A provider performs a revision of a total hip arthroplasty, replacing the femoral component, to address aseptic loosening.