1 stage exchange - Total Hip Revision, complicated

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Hello! I work at an orthopedic group and this is the first time I'm hearing of this. I will insert the doctor's description of the surgery farther down, but essentially they do a 2-stage revision for an infected THA in 1-stage. It's a seemingly very new procedure, and my coding manager and I are not sure on how to code this. Everything I can find says it's just a normal revision (27134) but I also found a description of the 1-stage where they use 2 surgical tables, 2 sets of instruments, they rescrub in the middle, close the patient in between, etc. to keep from cross-contaminating the field. This feels like way more that just adding a 22 modifier. Any and all suggestions are welcome!!!

From the surgeon:
"This is a challenging situation, it’s a super involved surgery, that is whats called a 1 stage exchange, were you remove a hip replacement, treat the infection, remove all of the infected tissue, then go right back in and then place a new non infected hip replacement. Its sort of all one surgery, but in the middle we close the patient up, take the drapes down, and then re prep and drape the patient and then open it back up and do the surgery with an entire new set of instruments."
 

amyjph

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A 22 is what you would need provided it is explained and justfied in the operative report. You would have to track the claim after to follow the reimbursement. There's nothing else to call it except 27134 if it's the same operative session, same anesthesia. I have seen it before but it's pretty uncommon. It would be best if there was a statement in the header to explain the procedure and these points below regarding the 22. The only other additional codes you "might" look at are 20700, 20702, or 20704 but I am not sure even those would be acceptable w/ 27134. Those are usually more for spacers during a two-stage. You could also check to see if they did a biopsy or frozen section during to check before proceeding with the new THA. I haven't checked on this lately so you may look at AAOS or CPT Asst but I am pretty sure there's no other choice.

Documentation to indicate that the work performed to provide the service was substantially greater then typically required.
  • Must support the substantial additional work
  • Reason for the additional work
    • Increased intensity
    • Time
    • Technical difficulty of procedure
    • Severity of patient's condition
    • Physical and mental effort required
 
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A 22 is what you would need provided it is explained and justfied in the operative report. You would have to track the claim after to follow the reimbursement. There's nothing else to call it except 27134 if it's the same operative session, same anesthesia. I have seen it before but it's pretty uncommon. It would be best if there was a statement in the header to explain the procedure and these points below regarding the 22. The only other additional codes you "might" look at are 20700, 20702, or 20704 but I am not sure even those would be acceptable w/ 27134. Those are usually more for spacers during a two-stage. You could also check to see if they did a biopsy or frozen section during to check before proceeding with the new THA. I haven't checked on this lately so you may look at AAOS or CPT Asst but I am pretty sure there's no other choice.

Documentation to indicate that the work performed to provide the service was substantially greater then typically required.
  • Must support the substantial additional work
  • Reason for the additional work
    • Increased intensity
    • Time
    • Technical difficulty of procedure
    • Severity of patient's condition
    • Physical and mental effort required
Thank you for your insight!! We were able to give him the bone biopsy code, he did both bones (femur and acetabulum). No medicated spacers were used, so we didn't code that.

27134,22,LT T84.098A, T84.52XA
20245 T84.52XA
 

Orthocoderpgu

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Thank you for your insight!! We were able to give him the bone biopsy code, he did both bones (femur and acetabulum). No medicated spacers were used, so we didn't code that.

27134,22,LT T84.098A, T84.52XA
20245 T84.52XA
You can't bill the bone biopsy if it was performed in the same surgical field as the THA. Check your NCCI edits.
 
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