Proper coding and billing for CPT 27134 — Revision of total hip arthroplasty, both acetabular and femoral components — is critical for orthopedic practices navigating complex joint revision cases. From understanding bundling rules with CPT 27132 to knowing when to apply modifier 22 and how to avoid post-operative care denials, this article provides an essential guide to ensuring accurate reimbursement and clean claims submission.

What Is CPT 27134?

CPT 27134 describes the revision of a previously placed total hip prosthesis, specifically both the acetabular and femoral components. This is a more complex and extensive procedure than a unilateral component revision, and it carries higher RVUs, longer operative time, and often a more difficult clinical course.

Code Descriptor:

"Revision of total hip arthroplasty; both components, with or without autograft or allograft."

• Global Period: 90 days
  
  
• RVUs (2025 est.): ~31.90
  
  
• Common Indications: Implant loosening, infection, periprosthetic fracture, instability/dislocation, hardware failure.

Bundling Matrix: CPT 27134 and Related Hip Revision Codes

Revision hip procedures often overlap with other codes, so understanding bundling rules is essential. Here's a simplified matrix showing the bundling relationship of CPT 27134 with related procedures:

Use NCCI edits or payer-specific CCI guidelines to check pairings. Avoid billing 27134 + 27132 or 27138 together — they describe parts of the same comprehensive service.

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Modifier 22: When Is It Appropriate for CPT 27134?

Modifier 22 (“Increased Procedural Services”) can be applied to CPT 27134 when the revision procedure involves significantly more work than usual — but payers are strict about documentation.

Valid Situations for Modifier 22:

• Massive bone loss requiring structural allograft
  
  
• Removal of broken, well-fixed components with significant difficulty
  
  
• Extensive fibrosis or scar tissue from multiple previous revisions
  
  
• Intraoperative fracture repair in addition to component revision
  
  

Invalid or Weak Uses:

• Routine removal of components
  
  
• Moderate blood loss alone
  
  
• Complex surgery without detailed explanation
  
  

Documentation Tips:

• Clearly state “Increased procedural complexity due to…” in the op note.
  
  
• Detail the added time, technique adjustments, and clinical challenges.
  
  
• Attach photos, implant logs, or additional operative records if possible.
  
  

Payers may request records when modifier 22 is used. Expect delays in reimbursement — be proactive with documentation.

Denial Patterns in Post-Op Care

Orthopedic practices often face denials related to post-operative visits or services during the 90-day global period for CPT 27134. Here's how to anticipate and avoid the most common pitfalls:

Top Denial Scenarios:

Coding Pearls for CPT 27134

• Do not unbundle component revisions — 27134 includes both sides.
  
  
• Check implants carefully — documentation of removed and replaced components supports the choice of revision code vs primary arthroplasty.
  
  
• Use appropriate diagnosis codes, such as:
  
  
  
  • T84.03XA – Mechanical complication of hip prosthesis
    
    
  • T84.53XA – Infection and inflammatory reaction due to internal joint prosthesis
    
    
  • M24.551 – Instability of right hip
    
    

Always code to the highest degree of specificity, and link the correct diagnosis to the CPT code.

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Sample Claim (CMS-1500) for CPT 27134

Final Takeaways

CPT 27134 covers complex revision of both hip components and should not be unbundled with codes like 27132 or 27138. Use modifier 22 only when extra work is clearly documented, such as difficult implant removal or severe scar tissue. During the 90-day global period, apply modifiers like 24, 58, 78, or 59 as needed to avoid common denials. Accurate diagnosis coding and strong documentation are key to clean claims and proper reimbursement for revision hip arthroplasty.

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