2025 CPT code 27091

Removal of hip prosthesis; complicated, including total hip prosthesis, methylmethacrylate with or without insertion of spacer.

Refer to the current CPT manual for detailed coding guidelines.

Modifiers may be applicable depending on the circumstances of the procedure, such as modifier 50 (bilateral procedure), 59 (distinct procedural service), 76 (repeat procedure), or others.Consult the CPT manual and NCCI edits.

Medical necessity is established when the removal of the hip prosthesis is deemed necessary to alleviate pain, address loosening, manage infection, or treat a fracture.Documentation should support that less invasive alternatives have been considered and ruled out.

The orthopedic surgeon is responsible for the surgical removal of the hip prosthesis, including careful dissection of soft tissues, handling of the sciatic nerve, removal of the acetabular and femoral components, and appropriate wound closure.In case of infection, the surgeon manages the infection and decides on the placement of a spacer. Post-operative care would also fall under the surgeon’s clinical responsibility.

IMPORTANT 27090 (Removal of hip prosthesis; uncomplicated) is used for simpler removals without the complexities described for 27091.

In simple words: The doctor surgically removes a damaged artificial hip joint. This may involve breaking the cement holding the joint in place and may include putting in a temporary spacer to keep the hip stable until a new joint can be put in.

This procedure involves the surgical removal of a total hip prosthesis.It includes removal of both components of the prosthesis, removal of bone cement (methylmethacrylate), and may involve the insertion of a spacer. The complexity arises from factors such as extensive scar tissue, requiring release of tendons or muscles; difficulty in removing the prosthesis due to bony ingrowth; or the need for a spacer due to infection. The procedure involves incision, soft tissue dissection, dislocation of the hip joint, removal of the acetabular and femoral components, cement removal, and wound closure.A spacer may be inserted to maintain joint space and prevent shortening of the extremity if immediate replacement is not feasible.

Example 1: A 70-year-old patient presents with loosening and pain from a total hip arthroplasty (THA) implanted 10 years prior.The surgeon performs a complicated removal (27091) due to significant bone cement and fibrous tissue ingrowth. A spacer is not required., A 65-year-old patient experiences a periprosthetic infection following THA. The surgeon performs a two-stage revision. The first stage involves removal of the infected prosthesis (27091), with placement of an antibiotic-impregnated spacer. A second surgery is planned later to insert a new prosthesis., An 80-year-old patient suffers a fracture around the stem of a THA. The surgeon performs a complicated removal (27091) of the prosthesis because the fracture necessitates complex soft tissue management to achieve adequate exposure. A spacer is inserted temporarily.

* Preoperative diagnosis justifying the removal.* Detailed operative report describing the procedure, including details of any complications encountered, tissue releases performed, and the type of spacer used (if any).* Intraoperative imaging (if used).* Postoperative imaging (if performed).* Pathology report (if applicable).* Documentation supporting medical necessity.

** The complexity of the removal procedure and the need for a spacer are key factors in selecting code 27091 over the simpler code 27090. Accurate documentation is crucial for proper reimbursement.

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