CPT 27132: Revision Total Hip Arthroplasty, Both Components Replaced
CPT code 27132 denotes a revision total hip arthroplasty in which both the femoral and acetabular components are removed and replaced, with or without autograft or allograft. This procedure is clinically significant nationwide because it addresses prosthetic failure, infection, instability, or periprosthetic bone loss and often requires complex reconstruction. Payers frequently apply specific medical necessity criteria and coverage rules to revision arthroplasty due to its clinical complexity and cost implications. Key payers in most analyses include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare.
Readers will find a concise overview of the clinical context for 27132, typical sites of service, and how this code relates to related procedural codes such as removal of hip prosthesis and intertrochanteric osteotomy. The publication summarizes common billing considerations, typical clinical indications, and the role of 27132 in care pathways for patients with failing hip prostheses or complex hip pathology. The piece also highlights common documentation elements and contract-level coverage variability to watch for when billing this high-acuity orthopedic procedure.
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Billing Code Overview
CPT code 27132 describes a surgical procedure to revise a previously operated hip joint by replacing both the femoral and acetabular components with a prosthesis, with or without use of autograft or allograft. This is a revision hip arthroplasty performed when a prior hip surgery (other than a primary total hip arthroplasty) requires replacement of both components of the artificial hip joint.
Service Type: Revision total hip arthroplasty, both components replaced
Typical Site of Service: Inpatient hospital or ambulatory surgical center, depending on clinical complexity and payer rules
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with a prior hip-preserving surgery for a benign neoplasm of the proximal femur now presents with progressive hip pain, mechanical dysfunction, and radiographic evidence of joint destruction. The patient has a history of prior open hip surgery (internal fixation and tumor excision) and now requires removal of damaged native articular surfaces and replacement with a total hip prosthesis. Preoperative workup includes orthopedic evaluation, staging of oncologic diagnosis when applicable, medical clearance, imaging (AP pelvis, frog-leg lateral, CT or MRI when needed), and discussion of risks including infection and need for bone graft (autograft/allograft). The surgical workflow includes exposure through prior surgical scar and altered anatomy, removal of residual hardware or heterotopic bone as indicated, preparation of the acetabulum and femoral canal, insertion of acetabular and femoral prosthetic components (with or without bone graft), intraoperative assessment of stability and leg length, and multilayer closure. Postoperative care involves inpatient monitoring for neurovascular status and blood loss, pain control, venous thromboembolism prophylaxis, early mobilization with physical therapy, and coordination of follow-up for wound checks and radiographic evaluation. Typical site of service: hospital inpatient or hospital outpatient surgery center for complex revision-type exposure; typical service type: major orthopedic reconstructive surgery (total hip replacement after prior non-arthroplasty hip surgery). Typical patient scenario: replacement of both femoral and acetabular components for symptomatic joint destruction after prior hip surgery for tumor or trauma, where diagnosis codes such as D16.21, C49.21, or L40.50 may be present depending on underlying pathology.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | When work or time is substantially greater than usual due to extensive dissection from prior surgery, tumor resection, or complex reconstruction. |
26 | Professional component | When reporting only the surgeon's professional component separate from technical facility reporting (rare for operative CPT but used with global billing splits). |
50 | Bilateral procedure | When both hips are replaced in the same operative session (uncommon for 27132 but applicable if performed concurrently). |
51 | Multiple procedures | When 27132 is reported with additional distinct procedures during the same session (e.g., concomitant osteotomy 27165). |
52 | Reduced services | When the surgeon performs a reduced portion of the procedure (for example, aborted or limited prosthetic exchange). |
53 | Discontinued procedure | When the procedure is terminated due to extenuating circumstances after anesthesia induction before completion. |
62 | Two surgeons | When two surgeons of different specialties perform distinct surgical portions (for example, orthopedic oncologic resection and reconstructive arthroplasty). |
78 | Unplanned return to OR by same surgeon following initial procedure for a related procedure during the postoperative period | For revision or reoperation within global period due to acute complication. |
79 | Unrelated procedure or service by same physician during the postoperative period | When an unrelated procedure is performed during the global period. |
80 | Assistant surgeon | When a surgical assistant (qualified resident or another surgeon) performs part of the case. |
81 | Minimum assistant surgeon | When a certified surgical assistant provides minimum assistance. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | When an APP provides primary assistant services during surgery (where payor accepts AS). |
RT | Right side | To indicate the procedure was performed on the right hip when lateral reporting is required. |
LT | Left side | To indicate the procedure was performed on the left hip when lateral reporting is required. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207X00000X | Orthopaedic Surgery | Primary specialty performing complex hip prosthetic replacement. |
207XS0114X | Orthopaedic Surgery of the Spine | Included in input; may be listed when a spine-orthopedics specialist is credentialed in the group, though not typically primary for hip arthroplasty. |
207XX0004X | Adult Reconstructive Orthopaedic Surgery | Subspecialty commonly performing complex reconstructive hip procedures including exchanges after prior hip surgery. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
C40.21 | Malignant neoplasm of long bones of right lower limb | Tumor involving proximal femur/hip can destroy joint surfaces and necessitate resection and prosthetic reconstruction. |
C40.22 | Malignant neoplasm of long bones of left lower limb | Same relevance for the left hip. |
C47.21 | Malignant neoplasm of peripheral nerves of right lower limb, including hip | Tumors involving periarticular soft tissues may require resection with joint reconstruction. |
C47.22 | Malignant neoplasm of peripheral nerves of left lower limb, including hip | Same relevance for the left hip. |
C49.21 | Malignant neoplasm of connective and soft tissue of right lower limb, including hip | Soft-tissue malignancy around the hip can lead to joint involvement and need for prosthetic replacement. |
C49.22 | Malignant neoplasm of connective and soft tissue of left lower limb, including hip | Same relevance for the left hip. |
D16.21 | Benign neoplasm of long bones of right lower limb | Benign bone tumors of the proximal femur may be managed with resection and reconstruction with prosthesis. |
D16.22 | Benign neoplasm of long bones of left lower limb | Same relevance for the left hip. |
D21.21 | Benign neoplasm of connective and other soft tissue of right lower limb, including hip | Periarticular benign soft-tissue masses may necessitate joint reconstruction. |
D21.22 | Benign neoplasm of connective and other soft tissue of left lower limb, including hip | Same relevance for the left hip. |
L40.50 | Arthropathic psoriasis, unspecified | Severe psoriatic arthropathy affecting the hip can lead to end-stage joint destruction requiring total hip replacement. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
27091 | Removal of hip prosthesis; complicated, including total hip prosthesis, methylmethacrylate with or without insertion of spacer | May be performed immediately prior to or as part of a staged exchange when explantation of prior prosthesis or complex hardware removal is required. |
27165 | Osteotomy, intertrochanteric or subtrochanteric including internal or external fixation and/or cast | May be performed concomitantly or in a staged fashion to correct deformity or adjust femoral alignment/leg length during reconstructive hip surgery. |