Total Joint replacement, Hemiarthroplasty or Revision? Which is it?

Surgeons often use the terms arthroplasty and replacement interchangeably to describe a procedure they are performing.  On occasion, they will also state that they are doing a revision.   As a coder,  it is essential to understand the procedures surgeons perform and most importantly, the anatomy of the structures they are working on.

Most commonly, I see these on hips, shoulders, and knees; however, this is not all-inclusive.  I have seen them on foot, ankle, wrists, and even elbows.

Let’s take a few minutes to review the difference between the various procedures/terms used for these types of procedures to lessen any burden you may have.

• Arthroplasty: A reconstructive surgery of a joint or joints to restore motion because of ankylosis or trauma or to prevent excessive motion.
• Total Joint Replacement:  A surgical procedure to replace an unhealthy joint with an artificial joint. The replacement surgery aims to relieve pain and restore the alignment and function of a diseased joint after conservative treatment options have failed. Conditions that may necessitate a replacement could include (but are not limited to) arthritis, fracture, or avascular necrosis.,
• Revision:  A procedure where the surgeon will remove all or some of the original prosthetic pieces and replace them with new ones. These usually take longer and are more complex than an initial joint replacement (watch the documentation as sometimes you may be able to capture modifier 22 for those types of cases). Conditions that may necessitate a revision could include (but are not limited to) damage to a previously placed implant, infection, wear and tear, loosening, or even a fall.
• Hemiarthroplasty:  A procedure that involves replacing only a piece or half of the joint.  The term “hemi” means “half.” For shoulders, you may see just the humerus, for the knee, only the tibial component, or in the hip, just the femoral component.  These are usually done for fractures; however not inclusive to just fractures.    

When you look in your CPT book, you will see that the term “hemiarthroplasty” is in the shoulder and hip section but not the knee.  I am not sure why CPT decided on the different verbiages between the different body structures, so it’s important to pay attention.

All of the above, whether it’s a total joint, reconstruction, revision, or hemiarthroplasty, will require the use of some sort of implant.  They may consist of silicone, metallic, ceramic, allografts, cancellous bone, etc.  The list goes on.

Just remember---- take time to learn the anatomy and surgical procedures to help sort out any confusion you may have between these terms.