Total Hip Arthroplasty (THA)

CPT 27130 · 19.11 wRVU · 90-day global
CPT27130
wRVU19.11
Global90-day
ApproachOpen
ComplexityHigh
Add-on / Variant CPTs
  • 27132 wRVU: 25.05 — Conversion of previous hip surgery to THA (25.05 wRVU, 90-day global) — alternative primary after prior open hip surgery on same hip; NOT for primary THA without prior surgery
  • 27134 wRVU: 29.52 — Revision THA, both acetabular and femoral components (29.52 wRVU, 90-day global) — alternative primary for revision; mutually exclusive with 27130
  • 27137 wRVU: 22.13 — Revision THA, acetabular component only (22.13 wRVU, 90-day global) — alternative primary for acetabular-only revision
  • 27138 wRVU: 23.11 — Revision THA, femoral component only (23.11 wRVU, 90-day global) — alternative primary for femoral-only revision
  • 27125 wRVU: 16.22 — Hemiarthroplasty, hip, prosthetic replacement (16.22 wRVU, 90-day global) — for elective/degenerative hemiarthroplasty (AVN, preserved acetabular cartilage); do NOT use for acute fracture (use 27236)
  • 27236 wRVU: 17.17 — Open treatment of femoral neck fracture with prosthetic replacement (17.17 wRVU, 90-day global) — for acute displaced femoral neck fracture treated with prosthetic replacement; do NOT use 27125 for fracture cases
Preoperative Diagnosis:

Right [left] hip [osteoarthritis / avascular necrosis / post-traumatic arthritis / inflammatory arthritis / hip dysplasia], end-stage, not responsive to conservative management

Postoperative Diagnosis:

Same

Procedure Performed:

Right [left] total hip arthroplasty via [posterior / direct anterior] approach, [implant manufacturer/model]

Attending Surgeon:

[Attending name], MD/DO

First Assistant:

[Resident/PA name]

Anesthesia:

Spinal [/ general endotracheal]

Indications:

The patient is a [age]-year-old [male/female] with end-stage right [left] hip [osteoarthritis / avascular necrosis] presenting with refractory hip pain and functional impairment refractory to at least [3] months of conservative management including physical therapy and analgesics. Radiographs demonstrate loss of joint space, subchondral sclerosis, and osteophyte formation. The risks, benefits, and alternatives including infection, dislocation, leg length discrepancy, nerve injury (sciatic, femoral, lateral femoral cutaneous), vascular injury, periprosthetic fracture, aseptic loosening, and need for revision were discussed. Informed consent was obtained.

Findings:

The femoral head was [spherical / flattened / osteophytic]. Articular cartilage was absent with eburnated bone on both the femoral head and acetabulum. The femoral head measured [X] mm in diameter. Implants: [X]-mm hemispherical acetabular shell at [X°] inclination/[X°] anteversion; [X]-mm [polyethylene / ceramic] liner; [X]-mm femoral stem; [X]-mm [ceramic / cobalt-chrome] femoral head.

Description of Procedure:

[POSTERIOR APPROACH:]
The patient was positioned in the lateral decubitus position with the operative hip up. A [X]-cm posterior incision was made centered over the greater trochanter. The fascia lata was incised. The piriformis, conjoint tendon (superior gemellus, obturator internus, inferior gemellus), and upper portion of the quadratus femoris were tagged and divided at the greater trochanter. The sciatic nerve was identified and protected. The posterior capsule was incised and the hip was dislocated posteriorly by internal rotation, adduction, and flexion.

The femoral neck was cut at the planned level with an oscillating saw. The femoral head was removed and measured. The acetabulum was prepared with sequential reamers to [X] mm. A press-fit [X]-mm acetabular shell was impacted at [X°] inclination and [X°] anteversion (targeting 40° inclination and 15–25° anteversion for posterior approach). [X] screws were placed for additional fixation. A [cross-linked poly / ceramic] liner was impacted.

The femoral canal was prepared with the broach sequence to size [X]. The femoral stem was trialed and leg length, offset, and stability assessed. The final [uncemented / cemented] [X] stem was implanted. A [X]-mm head was assembled. The hip was reduced and stability tested through [0–90° flexion] with no impingement.

The posterior capsule and short external rotators were repaired to the posterior greater trochanter with [No. 2 FiberWire] sutures through bone tunnels. The fascia lata was closed with [#1 Vicryl]. Skin was closed with [staples / 3-0 Monocryl].

Complications:

None

Specimens:

Femoral head sent to pathology [if indicated]

Estimated Blood Loss:

[X] mL

Drains:

None [Routine closed-suction drains are not recommended for primary THA per current evidence]

Disposition:

The patient was taken to the PACU in stable condition. Weight-bearing as tolerated. [Posterior approach: posterior hip precautions per surgeon preference — current evidence does not require routine precautions after posterior approach THA with capsular repair.] DVT prophylaxis initiated. Physical therapy initiated on postoperative day 1.

Epic SmartPhrase Version 
PREOPERATIVE DIAGNOSIS: Right/Left hip ***, end-stage
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: Right/Left THA, *** approach, *** implant
ATTENDING: ***, MD/DO
ASSISTANT: ***
ANESTHESIA: Spinal

INDICATIONS: .PTAGE-year-old .PTSEX with end-stage hip ***, failed *** months of conservative management. Consent obtained.

FINDINGS: Femoral head ***. Cartilage absent, eburnate. Implants: *** mm cup at ***°/***°, *** liner, *** stem, *** mm head.

PROCEDURE:
Lateral decubitus, operative hip up. Posterior incision. Fascia lata incised. Short external rotators (piriformis, conjoint tendon, upper quadratus femoris) tagged and divided. Sciatic nerve identified and protected. Posterior capsule incised; hip dislocated posteriorly (IR/adduction/flexion). Femoral neck cut at planned level. Head removed, *** mm. Acetabulum reamed to *** mm; *** mm shell impacted at ***°/***°; *** screws. *** liner impacted. Femoral canal broached to size ***. Trial: stable, LL/offset confirmed. Final stem implanted. Head assembled. Hip reduced; stable. Posterior capsule and short external rotators repaired to GT via bone tunnels (No. 2 FiberWire). Fascia lata closed. Skin closed.

EBL: *** mL
COMPLICATIONS: None
DISPOSITION: WBAT. DVT prophylaxis. PT POD 1.

Signed: .ME, .MYDEGREE
.TODAY
Variants

Direct anterior approach (DAA)

The patient is positioned supine on a [traction / standard] table. An anterior incision is made in the interval between the tensor fascia lata (TFL) and sartorius, utilizing the Smith-Petersen internervous plane (femoral nerve supplies sartorius; superior gluteal nerve supplies TFL). The lateral femoral cutaneous nerve is identified and protected — LFCN injury is the most common approach-specific complication. The hip capsule is incised in [T / H / inverted-T]-fashion. Hip dislocation is achieved with traction, external rotation, and hyperextension. Acetabular and femoral preparation proceed as in posterior approach. DAA preserves the short external rotators and posterior capsule, avoiding posterior hip precautions. Capsular repair or preservation at closure is recommended. Note: early functional advantages over posterior approach (with capsular repair) are modest and equalize by 3 months in randomized trials. Uses same CPT 27130.

Hip hemiarthroplasty — fracture (CPT 27236)

CPT 27236 (17.17 wRVU, 90-day global) for acute displaced femoral neck fracture treated with prosthetic replacement. Do NOT use 27125 (elective hemiarthroplasty) for fracture — this is among the most common orthopedic coding errors. Per AAOS 2021 CPG (Management of Hip Fractures in Older Adults) and the HEALTH trial (NEJM 2019), THA (27130) is preferred for ambulatory, cognitively intact, independently living patients with displaced femoral neck fractures; hemiarthroplasty is appropriate for non-ambulatory, cognitively impaired, or low-demand patients. Document the patient's functional status and rationale for hemiarthroplasty vs. THA. Hemiarthroplasty: only femoral component and bipolar head are implanted; native acetabular cartilage is retained. CPT 27125 (16.22 wRVU) is reserved for elective hemiarthroplasty — degenerative indications, AVN with preserved acetabular cartilage.

Charting Tips
  • Document cup inclination and anteversion with actual intraoperative measurements. The Lewinnek 'safe zone' (40° ± 10° inclination, 15° ± 10° anteversion) is a widely used reference, but contemporary evidence (Abdel et al. 2016) shows most dislocations occur within this zone — functional/spinopelvic positioning also matters. Document the measured angles; do not just write 'safe zone placement.' Acetabular malposition is the leading cause of instability and polyethylene wear failure.
  • Document posterior capsule and short external rotator repair for posterior approach. This step is most important for reducing posterior dislocation risk. Document technique (bone tunnels vs. suture anchors vs. direct capsulorrhaphy), suture type/size, and that repair was completed. Capsular repair significantly reduces posterior dislocation rates compared to unrepaired posterior approach.
  • Document sciatic nerve identification and protection for posterior approach. Post-THA sciatic nerve palsy is a known complication and a frequent source of litigation. Document: 'the sciatic nerve was identified and protected throughout.' This is particularly important for revision cases and complex anatomy.
  • Document leg length and offset comparison. Leg length discrepancy greater than 1 cm is a common source of patient dissatisfaction and litigation. Document intraoperative assessment method (preoperative template, intraoperative caliper from fixed pelvic pin to femur, fluoroscopic check) and final result relative to contralateral side.
  • Document implant UDI and full specifications. FDA UDI tracking is mandatory for hip prostheses (Class III devices). Record manufacturer, model, lot number, component sizes, and unique device identifiers for cup, liner, femoral stem, and femoral head. AJRR participation is voluntary but strongly encouraged.
Billing Tips
  • 27130 (arthroplasty, acetabular and proximal femoral prosthetic replacement — total hip arthroplasty, with or without autograft or allograft; 19.11 wRVU, 90-day global) is the primary code for all primary THA regardless of approach. Posterior, direct anterior, lateral (Hardinge), and anterolateral approaches all use 27130 — approach does not change the CPT. Document the approach, implant specifications (manufacturer, model, bearing surface, component sizes), and press-fit vs. cemented technique.
  • 27132 (conversion of previous hip surgery to total hip arthroplasty; 25.05 wRVU, 90-day global) applies when THA is performed after any prior open hip surgery on the same hip — including failed hemiarthroplasty, prior ORIF (screws, DHS, cephalomedullary nail), prior Girdlestone, or prior pelvic osteotomy. The key requirement is a prior open surgical procedure on the same hip joint. 27132 is NOT used for patients with prior arthroscopy alone (debated) or prior contralateral hip surgery. Document the prior procedure explicitly.
  • Revision THA component codes: 27134 (revision both acetabular and femoral components, 29.52 wRVU, 90-day global); 27137 (revision acetabular component only, 22.13 wRVU, 90-day global); 27138 (revision femoral component only, 23.11 wRVU, 90-day global). Code selection requires documentation of which component(s) were explanted and reimplanted. Do not use 27130 for revision cases. Second-stage reimplantation after infected THA typically uses 27134 (both components) — verify with payer. Modifier -58 (staged procedure) applies if planned as a staged procedure within the prior 90-day global.
  • Hip hemiarthroplasty: 27125 (hemiarthroplasty, hip, prosthetic replacement; 16.22 wRVU, 90-day global) for elective/degenerative indications (AVN, selected fracture). 27236 (open treatment of femoral fracture, proximal end, neck, with prosthetic replacement; 17.17 wRVU, 90-day global) for acute displaced femoral neck fracture with prosthetic replacement. Using 27125 instead of 27236 for an acute fracture case is one of the most common orthopedic coding errors — 27125 is for degenerative/elective hemiarthroplasty, not fracture treatment. Per the HEALTH trial (NEJM 2019), THA (27130) is now preferred over hemiarthroplasty for ambulatory, cognitively intact patients with displaced femoral neck fracture.
  • Implant documentation: FDA UDI (unique device identifier) tracking is mandatory for Class III implants including hip prostheses. Record manufacturer, model, lot number, component sizes, and UDI for cup, liner, femoral stem, and head for every case. The American Joint Replacement Registry (AJRR) is voluntary — not a state mandate. Mandatory FDA UDI documentation and voluntary AJRR participation are separate requirements.
  • 90-day global period. Closed reduction of dislocation under anesthesia within the global period uses modifier -78 (unplanned return to OR for complication). Second-stage revision (planned staged procedure) within the global period uses modifier -58. Modifier -79 applies to unrelated procedures during the global period. Modifier -78 does not reset the global period.

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