Introduction
Hip replacement surgeries are among the most commonly performed orthopedic procedures, helping patients regain mobility and reduce pain caused by arthritis or injury. Correct CPT coding is essential to ensure proper reimbursement and avoid claim denials. This guide covers the key CPT codes related to total hip arthroplasty (THA) and revision procedures, explaining their differences, billing considerations, and common documentation pitfalls.
Understanding Hip Replacement CPT Codes
Total hip arthroplasty (THA) involves replacing the hip joint with an artificial implant. Revision hip arthroplasty is a more complex procedure, often requiring removal and replacement of failed or worn-out prosthetic components. These procedures have different CPT codes based on complexity and components involved.
CPT Codes for Hip Replacement & Revision: Breakdown & Comparison
Primary Hip Replacement CPT Code
- 27130 – Total hip arthroplasty (THA), including acetabular and femoral components.
- Used for first-time total hip replacements.
- Common indications: Osteoarthritis, rheumatoid arthritis, avascular necrosis.
- Documentation tip: Ensure operative notes specify primary vs. revision procedure.
Revision & Removal CPT Codes
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27132 – Revision of total hip arthroplasty, with or without allograft; acetabular component only.
- Used when only the acetabular (hip socket) component is revised.
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27134 – Revision of total hip arthroplasty, with or without allograft; femoral component only.
- Used when only the femoral (thigh bone) component is revised.
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27137 – Revision of total hip arthroplasty, with or without allograft; both components.
- Used when both femoral and acetabular components are revised.
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27138 – Removal of prosthesis, total hip, without replacement.
- Used when prosthetic removal is performed without immediate implantation.
Related Procedures & Alternative Codes
- 27486 – Revision of total knee arthroplasty, with or without allograft; one component.
- 27487 – Revision of total knee arthroplasty, with or without allograft; both components.
- Although for knees, these codes follow similar principles as hip revisions and can be referenced for cross-procedural comparisons.
Billing Guidelines & Modifier Usage
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Common Modifiers:
- -RT/-LT – Identify right or left hip.
- -58 – Staged or related procedure by the same physician during the post-op period.
- -78 – Unplanned return to the OR for a related procedure by the same physician.
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Global Period Considerations:
- CPT 27130 (THA) has a 90-day global period under Medicare.
- Ensure follow-up visits within this period are coded correctly (e.g., 99024 for post-op visits).
Common Denials & How to Avoid Them
- Claim Denied as Duplicate: Ensure correct use of laterality modifiers (-RT, -LT).
- Medical Necessity Denial: Ensure pre-op documentation supports severe arthritis or joint dysfunction.
- Bundling Issues: Some insurers bundle revision codes improperly—always check CCI edits.
Final CPT Code Table: Descriptions & RVUs
| CPT Code | Description | RVU |
|---|---|---|
| 27130 | Total hip arthroplasty, with prosthetic acetabular and femoral components | 21.32 |
| 27132 | Revision of total hip arthroplasty; acetabular component only | 23.57 |
| 27134 | Revision of total hip arthroplasty; femoral component only | 24.15 |
| 27137 | Revision of total hip arthroplasty; both components | 27.18 |
| 27138 | Removal of prosthesis, total hip, without replacement | 16.89 |
| 27486 | Revision of total knee arthroplasty; one component | 25.64 |
| 27487 | Revision of total knee arthroplasty; both components | 29.11 |
Conclusion
Correct coding for hip replacement and revision procedures is crucial for reimbursement and compliance. Using the right CPT codes, applying proper modifiers, and understanding billing guidelines can help prevent denials and ensure accurate claims.
If you found this guide helpful, check out our other orthopedic coding guides on knee arthroplasty, shoulder replacement, and spine surgery!