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American Joint Replacement Registry

10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD10-PCS)

Registry Submission Triggering Code List

August 24, 2015

RRM – 8/24/2015 Added corrected codes and expanded the triggering code set due to errors in the reference document received.

R. Meinzer, AJRR Director of IT

meinzer@ajrr.net

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Contents Overview: ............................................................................................................................................................................ 3

Background: ...................................................................................................................................................................... 3

Anatomy of an ICD-10-PCS codes, and Operations and Root Operations for joint replacements . 3

ICD10-PCS Procedures .................................................................................................................................................. 6

Primary Total Hip and Knee Procedures ............................................................................................................ 7

Coding Primary Joint Replacement Procedures ......................................................................................... 7

Resurfacing maps to Supplement Operation Code .................................................................................. 7

Hip HemiArthoplasty and Partial HIP (ICD9-PCS 81.52).......................................................................... 8

Using the Revision Operation Code .................................................................................................................... 8

Reporting Codes Previously Referred to as Revisions in ICD9-PCS ........................................................ 9

Appendix 1 ICD9-PCS to ICD10-PCS and CPT mapping table .................................................................... 10

Appendix II Replacement and removal triggering Codes............................................................................. 20

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Overview: Currently submission of orthopedic hip and knee replacement procedures to the American Joint Replacement Registry (AJRR) is triggered by a list of ICD-9-PCS codes. These codes include both the primary and revision procedures collected by the registry and are subsequently used to produce quality metrics to the AJRR stakeholder community. In October of 2015, a transition to ICD-10 diagnosis and ICD-10-PCS procedure codes will occur requiring hospital to submit the new codes to both the Centers for Medicare & Medicaid Services (CMS) and payers depending on the patient’s coverage. The AJRR, in partnership with orthopedic societies and other orthopedic registries has identified the triggering codes for both primary (index) and revision procedures related to hip and knee joint replacement. This document provides background on the coding system, instructions on how to extract the codes, and the list of triggering codes that the AJRR will collect after the October 1st ICD-10 transition date. The following information is provided as guidance on what ICD-10-PCS replacements, supplements, revisions and removal / replacement procedures (revisions) the AJRR will be collecting. It is not intended as instructions for coding these procedures as institutional coding departments are authority in this area. The analysis AJRR conducted was based on the General Equivalence Mapping System (GEMS) provided by CMS.

Background: The International Classification of Diseases, 10th Revision (ICD-10) was developed in the 1980s by the World Health Organization and has been in use since the early 1990s. Over 25 countries currently use ICD-10. The diagnosis classification is a descendant of ICD-9 and previous versions of the International Classification of Diseases, and has been used by the international community in the reporting of diseases, causes of death, and other epidemiological statistics. The United States developed a more detailed clinical modification of ICD-10 to be used for diagnosis reporting for all medical encounters (ICD-10-CM). As a component of the transition the current ICD-9-PCS procedural reporting system will also transition to ICD-10-PCS .

Anatomy of an ICD-10-PCS codes, and Operations and Root Operations for joint replacements

Source: ICD-10-PCS Procedure Coding System (ICD-10-PCS) 2015 Tables and Index Available from: http://www.cms.gov/Medicare/Coding/ICD10/2015-ICD-10-PCS-and-GEMs.html

ICD-10-PCS codes contain 7 alphanumeric fields as described below. Following below is a description of the anatomy of the code for right total hip replacement with ceramic-on-poly bearing surface: 0SR904A

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Each alpha-numeric character position in the ICD-10-PCS code has a definition and corresponding set of legal characters as described in the ICD-10 coding requirements. ---------------------------------------------------------------------------------------------------------------- Section Body System Operation Body Part Approach Device Qualifier Character 1 Character 2 Character 3 Character 4 Character 5 Character 6 Character 7 0 S R 9 0 4 A MedSurg Lower Joints Replacement Hip Joint, Open Synthetic Uncemented Right Substitute Ceramic, on poly

--------------------------------------------------------------------------------------------- The following items include a detail and breakdown of the coding structure in general: Character 1: Section: [0]: Medical and Surgical All entries to AJRR qualify as “0” For example, “Section is defined as the general type of procedure (e.g., medical and surgical, obstetrics, imaging, administration, nuclear medicine, etc.). The first character of the procedure code always specifies the section. Character 2: Body system: [S]: Lower Joints [Q]: Lower Bones For example, the body system (Character 2) identifies the general anatomical region involved in the procedure. There are 31 body systems in ICD-10-PCS for the Medical and Surgical Section (character 0), however all entries to AJRR qualify as “S” or “Q” Character 3: Operations (most often used with joint replacements and revisions include the following)

Replacement [R]: Putting in or on biological or synthetic material that physically takes the place and/or function of all or a portion of a body part Supplement [U]: Putting in or on biological or synthetic material that physically reinforces and/or augments the function of a portion of a body part Removal [P]: Taking out or off a device from a body part Revision [W]: Correcting, to the extent possible, a portion of a malfunctioning device or the position of a displaced device.

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Extirpation [C]: Taking or cutting out solid matter from a body part

Character 4: Body part (in our case, this will be for hip or knee) For 0SR (Lower Joint Replacement) 9: Hip Joint, Right B: Hip Joint, Left A: Hip Joint, Acetabular Surface, Right E: Hip Joint, Acetabular Surface, Left T: Knee Joint, Femoral Surface, Right U: Knee Joint, Femoral Surface, Left V: Knee Joint, Tibial Surface, Right W: Knee Joint, Tibial Surface, Left For 0QR (Lower Bones Replacement) 4: Acetabulum, Right 5: Acetabulum, Left 6: Upper Femur, Right 7: Upper Femur, Left 8: Femoral Shaft, Right 9: Femoral Shaft, Left B: Lower Femur, Right C: Lower Femur, Left D: Patella, Right F: Patella, Left G: Tibia, Right H: Tibia, Left Character 5 Approach 0 Open 3 Percutaneous 4 Percutaneous Endoscopic Character 6 Device 0 Synthetic Substitute, Polyethylene

1 Synthetic Substitute, Metal 2 Synthetic Substitute, Metal on Polyethylene 3 Synthetic Substitute, Ceramic 4 Synthetic Substitute, Ceramic on Polyethylene J Synthetic Substitute

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B Resurfacing device 7 Autologous Tissue Substitute K Nonautologous Tissue Substitute

Character 7 Qualifier 9 Cemented A Uncemented Z No Qualifier The key to ICD-10-PCS is the first three characters of the code, which designates the body system and root operation. Each of the root operations is indexed into tables that identify valid additional characters. For example, the root operation 0SR with a body part of 9 (hip joint, right) allows only a surgical approach of 0 (open). The following are the root operations identified for joint replacements with a brief explanation: 0SR: Lower joint replacement (includes hip and knee joint) 0SP: Lower joint removal 0SU: Lower joint supplement 0SW: Lower joint revision 0QR: Lower bones, replacement (includes pelvic bones, acetabulum, upper

femur, femoral shaft, lower femur, patella, tibia) 0QP: Lower bones, removal 0QU: Lower bones, supplement 0QW: Lower bones, revision It is important to note that the hospital staff assigning the procedure codes are not at liberty to combine any of the choices listed in characters 1-7 at will; the “valid” combinations of characters appear by row in the ICD-10-PCS Tabular List published by CMS and available on their website. AJRR has identified those codes applicable to hip and knee replacement procedures and they attached in Appendix II of this document.

ICD10-PCS Procedures A complete list of replacement, removal, supplement and revision triggering codes is provided in Appendix II. Mapping of ICD9-PCS to ICD10-PCS is provided in Appendix I.

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Primary Total Hip and Knee Procedures

Additional Coding for Primary Joint Replacement Procedures

The ICD-10-PCS root operation for total or partial hip or knee replacements is replacement, which is defined as “putting in or on biological or synthetic material that physically takes the place and/or function of all or a portion of a body part.” The body part either will be right or left hip and knee joints. The approach will be open. If the procedure is performed on the right and left hip or knee joints, then two separate procedures are assigned to show the bilateral procedure.

The following are the choices for the device (character 6):

0 Synthetic Substitute, Polyethylene 1 Synthetic Substitute, Metal 2 Synthetic Substitute, Metal on Polyethylene 3 Synthetic Substitute, Ceramic 4 Synthetic Substitute, Ceramic on Polyethylene J Synthetic Substitute B Resurfacing device 7 Autologous Tissue Substitute K Nonautologous Tissue Substitute

For the qualifier (character 7), the choices include cemented, uncemented, or no qualifier. For example, a left total hip arthroplasty using a cemented stem and a metal-on-plastic articulating surface is classified to code 0SRB029.

Replacement includes taking out the body part (e.g., hip joint). According to the ICD-10-PCS Official Guidelines for Coding and Reporting, “Components of a procedure specified in the root operation definition and explanation are not coded separately. Procedural steps necessary to reach the operative site and close the operative site, including anastomosis of a tubular body part, are also not coded separately. Example: Resection of a joint as part of a joint replacement procedure is included in the root operation definition of Replacement and is not coded separately”.

Resurfacing maps to Supplement Operation Code

If the objective of the procedure is to reinforce or augment a previously replaced body part, the root operation of supplement is used, and this is defined as “putting in or on biologic or synthetic material that physically reinforces and/or augments the function of a portion of a body part.” Putting in a new acetabular liner would be an example of this type of procedure. Several procedures fall into the supplement classification and, for example, include:

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0SU90BZ Supplement Right Hip Joint with Resurfacing Device, Open Approach 0SUA0BZ Supplement Right Hip Joint, Acetabular Surface with Resurfacing

Device, Open Approach 0SUB0BZ Supplement Left Hip Joint with Resurfacing Device, Open Approach 0SUE0BZ Supplement Left Hip Joint, Acetabular Surface with Resurfacing Device,

Open Approach 0SUR0BZ Supplement Right Hip Joint, Femoral Surface with Resurfacing Device,

Open Approach 0SUS0BZ Supplement Left Hip Joint, Femoral Surface with Resurfacing Device,

Open Approach

Hip Hemi-Arthoplasty and Partial HIP (ICD9-PCS 81.52)

Partial hips (also known as Hemiarthroplasty) are typically conducted to repair a fracture of the head of the femur or acetabulum. These are coded as replacement procedures however they are coded to the specific portion of the joint replaced. Codes applicable include 0SRA0XY and 0SRE0XY for acetabulum and 0SRS0XY, OSRS for femoral surface. X= 0, 1,,3,J Note that for femoral surface 0=Synthetic substitute, polyethylene is not valid.

Y= A,9,Z

Examples:

0SRA07Z Replacement of Right Hip Joint, Acetabular Surface with Autologous Tissue Substitute, Open Approach

0SRE0JF Replacement of Right Hip Joint, Acetabular Surface with Synthetic Substitute, Metal, Open Approach

0SRR0JF Replacement of Right Hip Joint, Femoral Surface with Synthetic Substitute, Metal, Open Approach

0SRR0JG Replacement of Right Hip Joint, Femoral Surface with Synthetic Substitute, Ceramic, Open Approach

Using the Revision Operation Code

The definition for the Revision root operation provided in the 2014 ICD-10-PCS Reference Manual is “Correcting, to the extent possible, a malfunctioning or displaced device.” The root operation “Revision” is coded when the objective of the procedure is to correct the position or function of a previously placed device, without taking the entire device out and putting in a

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whole new device in its place. Revision can include correcting a malfunctioning device by taking out and/or putting in part, but not all, of the device.

Example procedures include: repositioning of Swan-Ganz catheter in superior vena cava, taking out loose screw and putting larger screw in fracture repair plate, right fibula, revision of left hip replacement with readjustment of the prosthesis, and adjustment of the position of the pacemaker.

Those procedures coded as revisions for hip and knee include the small subset of codes that designate a replacement of select implanted components such as acetabular liner. Examples of valid codes using the “W” position 3 Revision operation code follow directly below.

0SW90JZ Revision of Synthetic Substitute in Right Hip Joint, Open Approach

0SWB0JZ Revision of Synthetic Substitute in Left Hip Joint, Open Approach

Note that replacement of tibial surface with liner is coded as a removal and supplement procedure pair.

0SPC09Z Removal of liner from Right Knee Joint, Open Approach

With

0SUV09Z Supplement Right Knee Joint, Tibial Surface with Liner, Open Approach

0SPD09Z Removal of liner from Left Knee Joint, Open Approach

With

0SUW09Z Supplement Left Knee Joint, Tibial Surface with Liner, Open Approach

Reporting Codes Previously Referred to as Revisions in ICD9-PCS For the revision of joint replacements, the appropriate code assignment will depend on the intent of the procedure. If the objective is to adjust the device, then the appropriate root operation is revision, which is defined as “correcting, to the extent possible, a malfunctioning or displaced device.” If the objective is to remove and replace the device, then two root operations are now required in ICD-10-PCS, a replacement procedure and removal procedure. In other words, one code is assigned for the removal of the device used in the previous replacement procedure, and one code is assigned for the placement of a new device. AJRR will require submission of both the removal and replacement procedures to accurately identify what aspects of the primary procedure have changed.

Example 1: Total Revision of Right Knee Replacement

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The patient had a right total knee replacement performed nine years ago and now presents for a revision of the right total knee replacement. During surgery, the surgeon replaced the femoral, tibial, and patellar components in order to take advantage of the new more durable prosthetic components that were not available when the patient originally had his right knee replaced.

In ICD-9-CM, the alphabetic main term entry “Revision, sub terms knee replacement, total (all components)” identifies code 00.80. The code descriptor for 00.80 is “Revision of knee replacement, total (all components)” and is categorized under 00.8, “other knee and hip procedures”. ICD-9-CM also provides codes for revision of tibial component only (00.81), revision of femoral component only (00.82), and revision of patellar component only (00.83). If revision of two knee components is performed then the coding professional would code the appropriate two component codes. ICD-9-CM does not differentiate laterality. Therefore, the code would be the same if performed on the left knee rather than the right knee. No additional code is assigned to remove the original knee prosthesis.

In ICD-10-PCS the root operation for this procedure is “Replacement” as the objective of the procedure is to put in synthetic material that physically takes the place and function of the previously placed prosthesis. The Index main term entry is “Replacement, Joint, Knee, Right” which directs the coding professional to Table 0SR. The ICD-10-PCS code for this procedure is 0SRC0JZ. Similar to ICD-9-CM, ICD-10-PCS differentiates a total replacement versus replacement of only some of the knee components. In ICD-10-PCS the component(s) of the knee, as well as laterality, being replaced are captured by the fourth character, body part, of the code. Therefore, unlike ICD-9-CM, ICD-10-PCS captures whether the procedure was performed on the left versus the right knee. An additional code for Removal of the original prosthesis is also required in ICD-10-PCS (0SPC0JZ).

Appendix 1 ICD9-PCS to ICD10-PCS and CPT mapping table If the primary ICD10-PCS procedure code assigned to a patient matches one of the codes listed below the AJRR Level I and Level II data (when available) shall be extracted from the electronic medical record and submitted to the AJRR using the file format.

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Description

ICD9-CM code Description ICD10 combinations

CPT CODES

ICD10 CODE

THA 81.51 Total hip replacement

0SR90xx – Replacement of Right Hip Joint with Synthetic Substitute, Open Approach 0SRB0xx – Replacement of Left Hip Joint with Synthetic Substitute, Open Approach 27130

0SR90xx 0SRB0xx

Hemiarthroplasty 81.52

Partial hip replacement / Hemi-arthroplasty Unipolar or bipolar femoral head Note that this procedure only replaces the femoral head and not the acetabulum. Typically used for femoral fractures.

0SRR0xx - Femoral Head Surface Right 0SRS0xx - Femoral Head Surface Left 27125

0SRR0xx 0SRS0xx

Revision Hip Replacement 81.53

Revision of hip replacement not otherwise specified

0SW90xx (Right Hip) 0SWB0xx (Left Hip) 27134

0SW90xx 0SWB0xx

80.05 Arthrotomy for removal of prosthesis of hip

0SP90xx (Removal of Prosthesis (Right Hip) 0SPB0xx (Removal of Prosthesis Left hip) 27091

0SP90xx 0SPB0xx

00.70 Revision of hip replacement, both acetabular and femoral

0SR90xx (Hip Joint Right), With 0SP90JZ 0SRB0xx (Hip Joint Right), With 0SPB0JZ 27134

0SR90xx With 0SP90JZ 0SRB0xx With 0SPB0JZ

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00.71 Revision of hip replacement, acetabular component

0SRA0xx (Right Hip Joint Acetabular Surface), with 0SP90JZ 0SRE0xx (Left Hip Joint Acetabular Surface) , with 0SPB0JZ 27137

0SRA0xx With 0SP90JZ 0SRE0xx With 0SPB0JZ

00.72 Revision of hip replacement, femoral component

0SRR0xx (Right Hip Joint Femoral Surface), with 0SP90JZ 0SRS0xx (Left Hip Joint Femoral Surface) with 0SPB0JZ 27138

0SRR0xx With 0SP90JZ 0SRS0xx With 0SPB0JZ

00.73

Revision of hip replacement, acetabular liner and/or femoral head only

0SU90xx (Supplement Hip Joint Right with liner) 0SUA0xx (Hip Joint Right acetabular surface with liner) 0SUR0xx (Supplement Hip Joint Right, Femoral surface with liner) with 0SP909Z (Removal of Liner Right Hip Joint) 0SP90JZ )Removal of synthetic substitute Right Hip Joint 0SUB0xx (Hip Joint Left Supplement with Liner) 0SUE0xx (Hip Joint Left acetabular surface with liner) 27134

0SU90xx 0SUA0xx 0SUR0xx With 0SP909Z or 0SP90JZ 0SUB0xx 0SUE0xx 0SUS0xx

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0SUS0xx (Hip Joint Left, femoral surface with liner) With 0SPB09Z (Removal of Synthetic Substitute from Left Hip Joint) 0SPB0JZ Removal of synthetic substitute Left Hip Joint Note that the device character 6 will include details on the type of device used.

With 0SPB09Z Or 0SPB0JZ

This procedure does not have a corresponding ICD10-PCS code. (Coding is custom for normalization from ICD9 to ICD10) 00.74

Revision of hip bearing surface Note for normalization and to reduce confusion between removal and replacement of the entire hip system this is being coded, only to normalize, to Replacement of Right/Left Hip acetabular surface OSRE0XX – Left 0SRA0XX – Right

0SRA0xx - Replacement of right hip joint, acetabular surface 0SRE0xx - Replacement of left hip joint, acetabular surface 27137

0SRA0xx 0SRE0xx

Hip Resurfacing 00.85

Resurfacing hip, total, acetabulum and femoral head Note that CMS decided that since the effort is to conserve as much bone as possible that resurfacing should remain a supplement operation and also

0SUR0Bx - Supplement Right Hip Joint – Femoral surface with Resurfacing device, With 0SUA0Bx - Supplement Right Hip – Acetabular surface with resurfacing device.) 27130

0SUB0Bx 0SUA0Bx 0SUS0Bx 0SUE0Bx

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differentiates the procedure from a total hip.

0SUS0Bx - Supplement Left Hip Joint, Femoral Surface with Resurfacing Device 0SUE0Bx -Supplement Left Hip Joint with acetabular surface with resurfacing device Note the B in character position 6 is defined by CMS as "Resurfacing Device".

00.86 Resurfacing hip, partial, femoral head

0SUR0Bx (Supplement right hip joint, femoral surface with resurfacing device. 0SUS0Bx (Supplement left hip joint, femoral surface with resurfacing device. 27125

0SUR0Bx 0SUS0Bx

00.87 Resurfacing hip, partial, acetabulum

0SUA0Bx - (Supplement Right Hip Joint Acetabular Surface with resurfacing device), 0SUE0Bx (Supplement Left Hip Joint, Acetabular surface with resurfacing device.) 27125

0SUA0Bx 0SUE0Bx

Total Knee Arthroplasty

81.54 Total knee replacement

0SRD0xx - Replacement of Left Knee Joint 0SRC0xx - Replacement of Right Knee Joint 27447

0SRD0xx 0SRC0xx

80.06 Removal of Prosthesis Knee 0SPB0xx - Right Knee 0SPC0xx - Left Knee 27091

0SPB0xx 0SPC0xx

Patellar Resurfacing

No ICD9 Code

0SUD09C (Supplement Left Knee Joint with liner, Patellar Surface) 27438

0SUD09C 0SUC09C

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Or 81.96 Other repair of joint

0SUC09C (Supplement Right Knee joint with liner, Patellar Surface)

Patellar Resurfacing

No ICD9 Code

0QRF0JZ (Replacement of Left Patellar with synthetic substitute) 0QRD0JZ (Replacement of Right Patellar with synthetic substitute ) With 0SPC09Z (Removal of liner from right knee joint.) Or 0SPD09Z (Removal of liner from right knee joint.) 27438

0QRF0JZ With 0SPC09Z 0QRD0JZ With 0SPD09Z

Other repair, knee 81.47 Other repair, knee

Eliminated from AJRR triggering codes for ICD10 0SQC0XX

Revision Knee Replacement 81.55

Revision total knee replacement

0SWC0xx - Revision of synthetic substitute Right Knee joint 0SWD0xx - Revision of synthetic substitute Left Knee Joint 27487

0SWC0xx 0SWD0xx

0.80 Revision of knee replacement, all components

0SRC0xx (Replacement of Right Knee Joint with Synthetic substitute), With 0SPC0JZ (Removal of synthetic substitute Right Knee Joint)

0SRC0xx With 0SPC0JZ 0SRD0xx With 0SPD0JZ

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0SRD0xx (Replacement of Left Knee Joint with Synthetic substitute), With 0SPD0JZ (Removal of synthetic substitute Left Knee Joint)

0.81

Revision of knee replacement, tibial component including tibial insert

0SRV0JZ (Replacement of Right Knee Joint, Tibial surface with synthetic substitute) With 0SPC0JZ Removal of synthetic substitute Right Knee Joint 0SRW0xx (Replacement of Left Knee Joint, Tibial surface with synthetic substitute) With 0SPD0JZ Removal of synthetic substitute Left Knee Joint For replacement of tibial insert bearing only 0SUV09Z (Supplement Right Knee Joint, Tibial Surface with Liner, Open Approach)

With

0SPC09Z (Removal of liner from Right Knee Joint, Open Approach)

27486

0SRV0JZ With 0SPC0JZ 0SRW0JZ With 0SPD0JZ 0SUV09Z With 0SPC09Z 0SUW09Z With 0SPD09Z

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0SUW09Z (Supplement Left Knee Joint, Tibial Surface with Liner, Open Approach)

With

0SPD09Z (Removal of liner from Left Knee Joint, Open Approach

0.82

Revision of knee replacement, femoral component

0SRT0JZ (Replacement Right Knee Joint, Femoral Surface with Synthetic Substitute.) 0SUC0JZ (Supplement Right Knee Joint with Synthetic Substitute) 0SUT09Z (Supplement Right Knee Joint, Femoral Surface with Liner) With 0SPC09Z (Removal of liner right knee joint) 0SPC0JZ (Removal of synthetic substitute from Right Knee Joint) 0SRU0JZ (Replacement Left Knee Joint, Femoral Surface with Synthetic Substitute.) 0SUD0JZ (Supplement Left Knee Joint with Synthetic Substitute) 0SUU09Z (Supplement Left Knee Joint, Femoral Surface with Liner) With 27486

0SRT0JZ 0SUC0JZ 0SUT09Z With 0SPC09Z 0SPC0JZ 0SRU0JZ 0SUD0JZ 0SUU09Z with 0SPD09Z 0SPD0JZ

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0SPD09Z (Removal of liner left knee joint) 0SPD0JZ (Removal of synthetic substitute from Left Knee Joint)

0.83

Revision of knee replacement, patellar component

0QRD0JZ (Replacement of Right Patella with Synthetic substitute 0QUD0JZ Supplement of Right Patella with Synthetic substitute 0SUC09C - Supplement Right Knee Joint with Liner, Patellar Surface With 0QPD0JZ – Removal of Synthetic Substitute from Right Patella 0QRF0JZ (Replacement of Left Patella with Synthetic substitute 0QUF0JZ Supplement of Left Patella with Synthetic substitute 0QPF0JZ – Removal of Synthetic Substitute from Left Patella 27486

0QRD0JZ 0QUD0JZ 0SUC09C With 0QPD0JZ 0QRF0JZ 0QUF0JZ With 0QPF0JZ

0.84

Revision of knee replacement, isolated revision of tibial insert

0SUV09Z – Supplement Right Knee Joint, Tibial surface with Liner With 0SPC09Z – Removal of liner from Right Knee Joint 0SUW09Z – Supplement Left Knee Joint, Tibial Surface with Liner 27486

0SUV09Z With 0SPC09Z 0SUW09Z With

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With 0SPD09Z Removal of liner from Left Knee Joint

0SPD09Z

Unicondylar Knee

New to ICD-10 No ICD-9 Code

Replacement of one condyle of the knee with a femoral and tibial component.

0SRT0JZ (Replacement of Right Knee joint, femoral surface with synthetic substitute femoral), 0SRU0JZ (Left Femoral) 27446

0SRT0JZ 0SRU0JZ

Other

Insertion of cement spacer 84.56 Insertion of cement spacer

0SHB08Z - Left Hip 0SH908Z - Right Hip 0SHC08Z – Right Knee 0SHD08Z - Left Knee 11981

0SHB08Z 0SH908Z 0SHC08Z 0SHD08Z

Removal of cement spacer 84.57 Removal of cement spacer

0SPC08Z - Right Knee 0SPD08Z -Left Knee 0SPB08Z – Left Hip 0SP908Z – Right Hip 11982

0SHC08Z 0SHD08Z 0SPB08Z 0SP908Z

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Appendix II Replacement and Removal Triggering Codes  

Primary Procedures

0SR907Z Replacement of Right Hip Joint with Autologous Tissue Substitute, Open Approach, Unspecified

0SR902A Replacement of Right Hip Joint with Metal on Polyethylene Synthetic Substitute, Open Approach, Uncemented

0SR902Z Replacement of Right Hip Joint with Metal on Polyethylene Synthetic Substitute, Open Approach, Unspecified

0SR9019 Replacement of Right Hip Joint with Metal Synthetic Substitute, Open Approach, Cemented

0SR901A Replacement of Right Hip Joint with Metal Synthetic Substitute, Open Approach, Uncemented

0SR901Z Replacement of Right Hip Joint with Metal Synthetic Substitute, Open Approach, Unspecified

0SR90JZ Replacement of Right Hip Joint with Synthetic Substitute, Open Approach, Unspecified

0SR90J9 Replacement of Right Hip Joint with Synthetic Substitute, Open Approach, Cemented

0SR9029 Replacement of Right Hip Joint with Synthetic Substitute, Metal on Polyethylene, Open Approach, cemented

0SR90JA Replacement of Right Hip Joint with Synthetic Substitute, Open Approach, Uncemented

0SR903Z Replacement of Right Hip Joint with Ceramic Substitute, Open Approach, Unspecified

0SR9039 Replacement of Right Hip Joint with Ceramic Synthetic Substitute, Open Approach, Cemented

0SR903A Replacement of Right Hip Joint with Ceramic Synthetic Substitute, Open Approach, Uncemented

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0SR904A Replacement of Right Hip Joint with Ceramic on Polyethylene Synthetic Substitute, Open Approach, Uncemented

0SR904Z Replacement of Right Hip Joint with Ceramic on Polyethylene Synthetic Substitute, Open Approach, Unspecified

0SR9049 Replacement of Right Hip Joint with Ceramic on Polyethylene Synthetic Substitute, Open Approach, Cemented

0SR90KZ Replacement of Right Hip Joint with Nonautologous Tissue Substitute, Open Approach, Unspecified

0SRA00Z Replacement of Right Hip Joint, Acetabular Surface with

Polyethylene Synthetic Substitute, Open Approach, Unspecified 0SRA009 Replacement of Right Hip Joint, Acetabular Surface with

Polyethylene Synthetic Substitute, Open Approach, Cemented 0SRA00A Replacement of Right Hip Joint, Acetabular Surface with

Polyethylene Synthetic Substitute, Open Approach, Cemented 0SRA07Z Replacement of Right Hip Joint, Acetabular Surface with

Autologous Tissue Substitute, Open Approach 0SRA01A Replacement of Right Hip Joint, Acetabular Surface with Metal

Synthetic Substitute, Open Approach, Uncemented 0SRA019 Replacement of Right Hip Joint, Acetabular Surface with Metal

Synthetic Substitute, Open Approach, Cemented 0SRA01Z Replacement of Right Hip Joint, Acetabular Surface with Metal

Synthetic Substitute, Open Approach, Unspecified 0SRA039 Replacement of Right Hip Joint, Acetabular Surface with Ceramic

Synthetic Substitute, Open Approach, Cemented 0SRA03A Replacement of Right Hip Joint, Acetabular Surface with Ceramic

Synthetic Substitute, Open Approach, Uncemented 0SRA03Z Replacement of Right Hip Joint, Acetabular Surface with Ceramic

Synthetic Substitute, Open Approach, Unspecified 0SRA0JZ Replacement of Right Hip Joint, Acetabular Surface with

Synthetic Substitute, Open Approach

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0SRA0KZ Replacement of Right Hip Joint, Acetabular Surface with Nonautologous Tissue Substitute, Open Approach

0SRB029 Replacement of Left Hip Joint with Metal on Polyethylene Synthetic Substitute, Open Approach, Cemented

0SRB02A Replacement of Left Hip Joint with Metal on Polyethylene Synthetic Substitute, Open Approach, Uncemented

0SRB07Z Replacement of Left Hip Joint with Autologous Tissue Substitute, Open Approach

0SRB02Z Replacement of Left Hip Joint with Metal on Polyethylene Synthetic Substitute, Open Approach, Unspecified

0SRB039 Replacement of Left Hip Joint with Ceramic Synthetic Substitute, Open Approach, Cemented

0SRB03A Replacement of Left Hip Joint with Ceramic Synthetic Substitute, Open Approach, Uncemented

0SRB03Z Replacement of Left Hip Joint with Ceramic Synthetic Substitute, Open Approach, Unspecified

0SRB049 Replacement of Left Hip Joint with Ceramic on Polyethylene Synthetic Substitute, Open Approach, Cemented

0SRB04A Replacement of Left Hip Joint with Ceramic on Polyethylene Synthetic Substitute, Open Approach, Uncemented

0SRB04Z Replacement of Left Hip Joint with Ceramic on Polyethylene Synthetic Substitute, Open Approach, Unspecified

0SRB019 Replacement of Left Hip Joint with Metal Synthetic Substitute, Open Approach, Cemented

0SRB01A Replacement of Left Hip Joint with Metal Synthetic Substitute, Substitute, Open Approach, Uncemented

0SRB01Z Replacement of Left Hip Joint with Metal Synthetic Substitute, Substitute, Open Approach, Unspecified

0SRB0J9 Replacement of Left Hip Joint Synthetic Substitute, Open Approach, Cemented

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0SRB0JA Replacement of Left Hip Joint Synthetic Substitute, Open Approach, Uncemented

0SRB0JZ Replacement of Left Hip Joint with Synthetic Substitute, Open Approach, Unspecified

0SRB0KZ Replacement of Left Hip Joint with Nonautologous Tissue Substitute, Open Approach

0SRC07Z Replacement of Right Knee Joint with Autologous Tissue Substitute, Open Approach, Unspecified

0SRC0JZ Replacement of Right Knee Joint with Synthetic Substitute, Open Approach

0SRC0KZ Replacement of Right Knee Joint with Nonautologous Tissue Substitute, Open Approach

0SRC0J9 Replacement of Right Knee Joint with Nonautologous Tissue Substitute, Open Approach, Uncemented

0SRC0JA Replacement of Right Knee Joint with Nonautologous Tissue Substitute, Open Approach, Cemented

0SRD07Z Replacement of Left Knee Joint with Autologous Tissue

Substitute, Open Approach 0SRD0JZ Replacement of Left Knee Joint with Synthetic Substitute, Open

Approach 0SRD0KZ Replacement of Left Knee Joint with Nonautologous Tissue

Substitute, Open Approach 0SRD0J9 Replacement of Left Knee Joint with Nonautologous Tissue

Substitute, Open Approach, Uncemented 0SRD0JA Replacement of Left Knee Joint with Nonautologous Tissue

Substitute, Open Approach, Cemented 0SRE07Z Replacement of Left Hip Joint, Acetabular Surface with

Autologous Tissue Substitute, Open Approach

24  

0SRE0JZ Replacement of Left Hip Joint, Acetabular Surface with Synthetic Substitute, Open Approach

0SRE0KZ Replacement of Left Hip Joint, Acetabular Surface with Nonautologous Tissue Substitute, Open Approach

0SRE01A Replacement of Left Hip Joint, Acetabular Surface with Metal Synthetic Substitute, Open Approach, Uncemented

0SRE019 Replacement of Left Hip Joint, Acetabular Surface with Metal Synthetic Substitute, Open Approach, Cemented

0SRE01Z Replacement of Left Hip Joint, Acetabular Surface with Metal Synthetic Substitute, Open Approach, Unspecified

0SRE039 Replacement of Left Hip Joint, Acetabular Surface with Ceramic Synthetic Substitute, Open Approach, Cemented

0SRE03A Replacement of Left Hip Joint, Acetabular Surface with Ceramic Synthetic Substitute, Open Approach, Uncemented

0SRE03Z Replacement of Left Hip Joint, Acetabular Surface with Ceramic Synthetic Substitute, Open Approach, Unspecified

0SRE0J9 Replacement of Left Hip Joint, Acetabular Surface with Synthetic Substitute, Open Approach, Cemented

0SRE0JA Replacement of Left Hip Joint, Acetabular Surface with Synthetic Substitute, Open Approach, Uncemented

0SRE009 Replacement of Left Hip Joint, Acetabular Surface with Polyethylene Synthetic Substitute, Open Approach, Cemented

0SRE00A Replacement of Left Hip Joint, Acetabular Surface with Polyethylene Synthetic Substitute, Open Approach, Uncemented

0SRE00Z Replacement of Left Hip Joint, Acetabular Surface with Polyethylene Synthetic Substitute, Open Approach, Unspecified

0SRR07Z Replacement of Right Hip Joint, Femoral Surface with Autologous

Tissue Substitute, Open Approach 0SRR01Z Replacement of Right Hip Joint, Femoral Surface with Metal

Synthetic Substitute, Open Approach, Unspecified

25  

0SRR03Z Replacement of Right Hip Joint, Femoral Surface with Ceramic Synthetic Substitute, Open Approach, Unspecified

0SRR019 Replacement of Right Hip Joint, Femoral Surface with Metal Synthetic Substitute, Open Approach, Cemented

0SRR01A Replacement of Right Hip Joint, Femoral Surface with Metal Synthetic Substitute, Open Approach, Uncemented

0SRR039 Replacement of Right Hip Joint, Femoral Surface with Ceramic Synthetic Substitute, Open Approach, Cemented

0SRR03A Replacement of Right Hip Joint, Femoral Surface with Ceramic Synthetic Substitute, Open Approach, Uncemented

0SRR0J9 Replacement of Right Hip Joint, Femoral Surface with Synthetic Substitute, Open Approach, Cemented

0SRR0JA Replacement of Right Hip Joint, Femoral Surface with Synthetic Substitute, Open Approach, Uncemented

0SRR0JZ Replacement of Right Hip Joint, Femoral Surface with Synthetic Substitute, Open Approach

0SRR0KZ Replacement of Right Hip Joint, Femoral Surface with Nonautologous Tissue Substitute, Open Approach

0SRS07Z Replacement of Left Hip Joint, Femoral Surface with Autologous

Tissue Substitute, Open Approach 0SRS01Z Replacement of Left Hip Joint, Femoral Surface with Synthetic

Substitute, Metal, Open Approach 0SRS03Z Replacement of Left Hip Joint, Femoral Surface with Synthetic

Substitute, Ceramic, Open Approach 0SRS0JZ Replacement of Left Hip Joint, Femoral Surface with Synthetic

Substitute, Open Approach 0SRS019 Replacement of Left Hip Joint, Femoral Surface with Metal

Synthetic Substitute, Open Approach, Cemented 0SRS01A Replacement of Left Hip Joint, Femoral Surface with Metal

Synthetic Substitute, Open Approach, Uncemented

26  

0SRS039 Replacement of Left Hip Joint, Femoral Surface with Ceramic Synthetic Substitute, Open Approach, Cemented

0SRS03A Replacement of Left Hip Joint, Femoral Surface with Ceramic Synthetic Substitute, Open Approach, Uncemented

0SRS0J9 Replacement of Left Hip Joint, Femoral Surface with Synthetic Substitute, Open Approach, Cemented

0SRS0JA Replacement of Left Hip Joint, Femoral Surface with Synthetic Substitute, Open Approach, Uncemented

0SRS0KZ Replacement of Left Hip Joint, Femoral Surface with Nonautologous Tissue Substitute, Open Approach

0SRT0J9 Replacement of Right Knee Joint, Femoral Surface with Synthetic Substitute, Open Approach, Cemented

0SRT07Z Replacement of Right Knee Joint, Femoral Surface with Autologous Tissue Substitute, Open Approach, Unspecified

0SRT0JA Replacement of Right Knee Joint, Femoral Surface with Synthetic Substitute, Open Approach, Uncemented

0SRT0JZ Replacement of Right Knee Joint, Femoral Surface with Synthetic Substitute, Open Approach

0SRT0KZ Replacement of Right Knee Joint, Femoral Surface with Nonautologous Tissue Substitute, Open Approach

0SRU07Z Replacement of Left Knee Joint, Femoral Surface with

Autologous Tissue Substitute, Open Approach 0SRU0JZ Replacement of Left Knee Joint, Femoral Surface with Synthetic

Substitute, Open Approach, Unspecified 0SRU0KZ Replacement of Left Knee Joint, Femoral Surface with

Nonautologous Tissue Substitute, Open Approach 0SRU0J9 Replacement of Left Knee Joint, Femoral Surface with Synthetic

Substitute, Open Approach, Cemented 0SRU0JA Replacement of Left Knee Joint, Femoral Surface with Synthetic

Substitute, Open Approach, Uncemented

27  

0SRV07Z Replacement of Right Knee Joint, Tibial Surface with Autologous

Tissue Substitute, Open Approach 0SRV0JZ Replacement of Right Knee Joint, Tibial Surface with Synthetic

Substitute, Open Approach 0SRV0KZ Replacement of Right Knee Joint, Tibial Surface with

Nonautologous Tissue Substitute, Open Approach 0SRV0JA Replacement of Right Knee Joint, Tibial Surface with Synthetic

Substitute, Open Approach, Uncemented 0SRV0J9 Replacement of Right Knee Joint, Tibial Surface with Synthetic

Substitute, Open Approach, Cemented 0SRW07Z Replacement of Left Knee Joint, Tibial Surface with Autologous

Tissue Substitute, Open Approach 0SRW0JZ Replacement of Left Knee Joint, Tibial Surface with Synthetic

Substitute, Open Approach 0SRW0KZ Replacement of Left Knee Joint, Tibial Surface with

Nonautologous Tissue Substitute, Open Approach 0SRW0JA Replacement of Left Knee Joint, Tibial Surface with Synthetic

Substitute , Open Approach, Uncemented 0SRW0J9 Replacement of Left Knee Joint, Tibial Surface with Synthetic

Substitute , Open Approach, Cemented 0SU90BZ Supplement Right Hip Joint with Resurfacing Device, Open

Approach 0SU907Z Supplement Right Hip Joint with Autologous Tissue Substitute,

Open Approach 0SU909Z Supplement Right Hip Joint with Liner, Open Approach 0SU90JZ Supplement Right Hip Joint with Synthetic Substitute, Open

Approach

28  

0SU90KZ Supplement Right Hip Joint with Nonautologous Tissue Substitute, Open Approach

0SUA0BZ Supplement Right Hip Joint, Acetabular Surface with Resurfacing

Device, Open Approach 0SUA09Z Supplement Right Hip Joint, Acetabular Surface with Liner, Open

Approach 0SUB0BZ Supplement Left Hip Joint with Resurfacing Device, Open

Approach 0SUB09Z Supplement Left Hip Joint with Liner, Open Approach 0SUB0JZ Supplement Left Hip Joint Synthetic Substitute, Open Approach 0SUB07Z Supplement Left Hip Joint Autologous Tissue Substitute, Open

Approach 0SUB0KZ Supplement Left Hip Joint Nonautologous Tissue Substitute,

Open Approach 0SUC09C Supplement Right Knee Joint with Liner, Patellar Surface, Open

Approach 0SUC0JZ Supplement Right Knee Joint with Synthetic Substitute, Open

Approach 0SUC09Z Supplement Right Knee Joint with Liner, Open Approach 0SUC0KZ Supplement Right Knee Joint with Nonautologous Tissue

Substitute, Open Approach 0SUC07Z Supplement Right Knee Joint with Autologous Tissue Substitute,

Open Approach 0SUD09C Supplement Left Knee Joint with Liner, Patellar Surface, Open

Approach 0SUD0JZ Supplement Left Knee Joint with Synthetic Substitute, Open

Approach

29  

0SUD09Z Supplement Left Knee Joint with Liner, Open Approach 0SUD0KZ Supplement Left Knee Joint with Nonautologous Tissue

Substitute, Open Approach 0SUD07Z Supplement Left Knee Joint with Autologous Tissue Substitute,

Open Approach 0SUE0BZ Supplement Left Hip Joint, Acetabular Surface with Resurfacing

Device, Open Approach 0SUE09Z Supplement Left Hip Joint, Acetabular Surface with Liner, Open

Approach 0SUF0JZ Supplement Left Patella with Synthetic Substitute, Open

Approach 0SUR0BZ Supplement Right Hip Joint, Femoral Surface with Resurfacing

Device, Open Approach 0SUR09Z Supplement Right Hip Joint, Femoral Surface with Liner, Open

Approach 0SUS0BZ Supplement Left Hip Joint, Femoral Surface with Resurfacing

Device, Open Approach 0SUS09Z Supplement Left Hip Joint, Femoral Surface with Liner, Open

Approach 0SUT09Z Supplement Right Knee Joint, Femoral Surface with Liner, Open

Approach 0SUU09Z Supplement Left Knee Joint, Femoral Surface with Liner, Open

Approach

30  

0SUV09Z Supplement Right Knee Joint, Tibial Surface with Liner, Open

Approach 0SUW09Z Supplement Left Knee Joint, Tibial Surface with Liner, Open

Approach 0SWC0JZ Revision of Synthetic Substitute in Right Knee Joint, Open

Approach 0SWC09Z Revision of Liner in Right Knee Joint, Open Approach 0SWD0JZ Revision of Synthetic Substitute in Left Knee Joint, Open

Approach 0SWD09Z Revision of Liner in Left Knee Joint, Open Approach 0QRF0JZ Replacement of Left Patella with Synthetic Substitute, Open

Approach 0QRD0JZ Replacement of Right Patella with Synthetic Substitute, Open

Approach 0QUF0JZ Supplement Left Patella with Synthetic Substitute, Open

Approach 0QUD0JZ Supplement Right Patella with Synthetic Substitute, Open

Approach 0SW90JZ Revision of Synthetic Substitute in Right Hip Joint, Open

Approach 0SW909Z Revision of Liner in Right Hip Joint, Open Approach 0SW90BZ Revision of Resurfacing Device in Right Hip Joint, Open Approach

31  

0SWB0JZ Revision of Synthetic Substitute in Left Hip Joint, Open Approach 0SWB09Z Revision of Liner in Left Hip Joint, Open Approach 0SWB0BZ Revision of Resurfacing Device in Left Hip Joint, Open Approach Spacer Insertion Codes involved with implant of antibiotic or other joint spacers 0SHB08Z Insertion of spacer into left hip joint, open approach 0SH908Z Insertion of spacer into right hip joint, open approach 0SHC08Z Insertion of spacer into right knee joint, open approach 0SHD08Z Insertion of spacer into left knee joint, open approach Revision codes removals Note that these codes must have a corresponding replacement code from the list of operating procedures above.

Note that specifics on the materials, are not allowed in character positions 6 such as synthetic substitute polyethylene = 0. The only code allowed in position 6 is J. Specific body parts such as acetabular surface = A are not accepted for the removal procedures only the less specific right/left hip joint=9,B or right/left knee joint = 0,4

0SP90JZ Removal of Synthetic Substitute from Right Hip Joint, Open

Approach 0SP908Z Removal of Spacer from Right Hip Joint, Open Approach 0SP909Z Removal of Liner from Right Hip Joint, Open Approach 0SP90BZ Removal of Resurfacing Device from Right Hip Joint, Open

Approach 0SPB0JZ Removal of Synthetic Substitute from Left Hip Joint, Open

Approach 0SPB08Z Removal of Spacer from Left Hip Joint, Open Approach

32  

0SPB09Z Removal of Liner from Left Hip Joint, Open Approach 0SPB0BZ Removal of Resurfacing Device from Left Hip Joint, Open

Approach 0SPC0JZ Removal of Synthetic Substitute from Right Knee Joint, Open

Approach 0SPC08Z Removal of Spacer from Right Knee Joint, Open Approach 0SPC09Z Removal of Liner from Right Knee Joint, Open Approach 0SPD0JZ Removal of Synthetic Substitute from Left Knee Joint, Open

Approach 0SPD09Z Removal of Liner from Left Knee Joint, Open Approach 0SPD08Z Removal of Spacer from Left Knee Joint, Open Approach 0QPF0JZ Removal of Synthetic Substitute from Left Patella, Open

Approach