Wiki periprosthetic fracture

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RebeccaMoney

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I need help with CPT(s) on the following procedure. An elderly man recently had a THA and fell sustaining a periprosthetic fx of the medial calcar wall with displacement of his femoral prosthesis. Procedure: Left Total hip revision with long stem femoral component and cabling calcar fx. The op note talks about dislocating the hip and took out the femoral head ball. We could see the medial calcar fx with displacement and removed the femoral components.We placed a trial component proximal portion in slight anteversion. We reduced this and placed two Isoelastic cerclage system wires, 1 distal and 1 proximal. Two more locking Isoelastic cerclage system cables were placed and reduced. We then removed the trial components. We copiously irrigated out and placed in the actual 150mm of distal component. Doctor gave me two codes : 27138 and 27269. Do you agree that both of these would be billable for this procedure? Thank you,
 
Hi Rebecca, Since this is a fracture, this would not be considered a revision of a total hip. I was actually looking more towards 27245. The calcar portion of the femur is considered subtrochanteric/intertrochanteric, since it is almost at the same level but more posterior than the lesser trochanter. 27245 states that it is an intermedullary implant with cerclage wires. If the femoral head was changed as well, perhaps 27236. This is a prosthetic femoral implant with femoral head prosthetic as well. I would use an "8" code first for the fracture along with the date of injury, 996.44, 996.42 and V43.64. That way, the diagnosis codes paint a better picture of why the procedure is being performed and the codes utilized. I hope this helps.
 
My apologies. I should have been more clear. You cannot use both codes at the same time. If the surgeon used an intermedullary implant only, use 27245. If he used intermedullary implant with replacement of femoral head, I would use 27236. You can use cable technique with either of these.
 
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