AHA Coding Clinic® for HCPCS - 2023 Quarter 3; Ask the Editor

THA revision with replacement of liner and femoral head

A patient with a history of right total hip arthroplasty (THA) presents with a diagnosis of osteoarthritis and polyethylene liner wear. The previous direct anterior incision was utilized. Dissection was carried down to the tensor fascia and dissection carried around to the tensor muscle. A vertical capsulotomy was made, the capsule was retracted laterally, and a synovectomy was performed of the lateral quadrant. The retractor was then placed posterior to the acetabular component. The hip was flexed, a retractor was placed, and synovectomies were performed in the anterosuperior and the anteroinferior quadrants exposing the edge of the acetabular component. The hip was dislocated, and the femoral head was extracted. The femoral neck was then retracted posteriorly exposing the posterior inferior quadrant. The final synovectomy was performed along the medial aspect of the femoral neck and exposing the entire periphery of the acetabular component. The liner was removed and there was evidence of polyethylene wear as well as small fracture of the polyethylene liner. The components and wound were washed, and the new liner was secured into place using the impactor and mallet. The 32 + 0 mm trial head was then trialed, revealing good stability throughout range of motion. The hip was dislocated again, trial head was removed, the neck of the femur was washed, and the new 32 + 0 mm head was malleted into place using the head impactor. The hip was reduced and was stable throughout range of motion. C-arm confirmed sizing.  What are the correct codes for a revision of a total hip arthroplasty with a femoral head and liner replacement but not the femoral stem (neck)? ...

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