27125

Hemiarthroplasty, hip, prosthesis (e.g., femoral head, acetabulum); without acetabulum preparation or fixation

CPT code 27125 describes a hip hemiarthroplasty procedure where only the femoral component (femoral head and stem) is replaced with a prosthesis, and there is no preparation, reaming, or fixation of the native acetabulum. This procedure is typically performed for conditions primarily affecting the femoral head, such as displaced femoral neck fractures in patients without pre-existing acetabular pathology, where the acetabular cartilage is deemed healthy and intact. The prosthetic femoral head articulates directly with the patient's own acetabular cartilage.

Clinical Indications

  • Displaced femoral neck fractures in elderly patients with intact acetabular cartilage and low functional demand, or where total hip arthroplasty is contraindicated.
  • Femoral neck fractures in patients with severe osteopenia or comminution making internal fixation difficult.
  • Avascular necrosis (AVN) of the femoral head where the acetabulum is preserved and healthy.
  • Selected cases of failed internal fixation of femoral neck fractures.
  • Non-union of femoral neck fractures where acetabular cartilage is in good condition.

Procedure Steps

  1. Patient positioning (typically lateral or supine) and sterile preparation of the surgical site.
  2. Surgical incision (e.g., posterolateral, anterior, or direct anterior approach) to access the hip joint.
  3. Dislocation of the femoral head from the acetabulum.
  4. Resection of the native femoral head at the appropriate level (e.g., femoral neck osteotomy).
  5. Preparation of the femoral canal by reaming and broaching to fit the selected femoral stem component.
  6. Insertion of the trial femoral stem and head to assess stability and leg length.
  7. Insertion of the definitive femoral stem (cemented or uncemented) into the femoral canal.
  8. Placement of the appropriate size prosthetic femoral head onto the stem.
  9. Reduction of the hip joint, ensuring the prosthetic head articulates with the native acetabulum.
  10. Assessment of hip stability, range of motion, and leg length.
  11. Layered closure of the surgical wound.

Coding Guidelines

  • CPT 27125 is reported for unilateral procedures. If performed bilaterally, append modifier 50 to the code.
  • This code has a 90-day global surgical period.
  • Documentation must clearly state that the acetabulum was not prepared or fixated, distinguishing it from total hip arthroplasty codes (e.g., 27130).
  • Do not report 27125 in conjunction with codes for acetabular reaming, preparation, or insertion of an acetabular component.
  • The use of appropriate laterality modifiers (RT for right, LT for left) is required when billing for unilateral procedures.
  • Pre-operative imaging (X-rays, MRI, CT) supporting the diagnosis and surgical plan should be documented.

Associated ICD-10 Codes