Wiki Help with hip sx


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Can anyone help with the following:

Postoperative diagnosis:
Infected and fractured right bipolar hip arthroplasty.

Procedure: (from op report)
1. Removal of Bipolar hip replacement.
2. Insertion of Prostalac unipolar antibiotic hip spacer.
3. Ostectomy of patient's existing calcar fracture.:confused:
4. Irrigation and debridement, deep, of patient's right hip prosthesis.

Op note states:
Once the debridement and irrigation had been performed with 9 liters of antibiotic solution in total, the ostectomy was performed. This was a calcar fracture that involved about 40% of the patient's proximal femur. Normally I would have liked to have attempted to fix this with a wire. Under the circumstances I do not think that would benefit the patient. this bone, as far as I'm concerned, served nothing more than a nidus for more infection. The ostectomy was performed. The patient's iliopsoas muscle did have to be released.

For first procedure I am using CPT code 27091. I can't find a code for second procedure, do I use an the unlisted procedure code? Also can I bill the debridement seperately or is this included 27091. It does state in op report that an aggressive depbridement was performed.

Any help with this would be very much apprecitated.
K. Estes CPC

27091 according to the CPT book the spacer is included and according to AAOS debridgement would be included in the global package. Prostalac is a spacer made of antibiotic loaded acrylic cement.