Wednesday, August 21, 2013

HIP Replacement

HIP Replacement Bearing Surface Vol.3 Codes

Q.   We are having a problem in trying to use the new ICD-9 CM procedure codes for hip replacement bearing surfaces: 00.74, 00.75, and 00.76.  While we understand that the bearing surfaces involve the materials used for the femoral heads and the liners or inserts within the acetabular shells that articulate with these femoral head components, our surgeons often fail to identify these materials in the operative reports, forcing us to search for the product stickers in the chart or to go on the manufacturer’s website to find the information we need.  Is there any centralized resource that we can go to that lists the names of the major metal, polyethylene, and ceramic components available for hip replacement as well as the names of the manufacturers who produce these components.  That would save us a lot of time.

A.   To the best of our knowledge, there is no centralized resource that does exactly what you request.  As an attempt to remedy this situation, we have a compiled a list below of the most commonly used manufacturers and their bearing surface products matching them to the materials described in the new ICD-9 CM procedure codes:

00.74  Hip replacement bearing surface, metal on polyethylene

Biomet (

       Endo II cobalt chrome femoral head
       Modular cobalt chrome femoral head
       Offset cobalt chrome femoral head
       ArCom polyethylene liners
       ArComXL highly cross-linked polyethylene liners

DePuy Orthopedics, Inc. (

       Articuleze cobalt chrome femoral heads
       Enduron polyethylene liners
       Marathon cross-linked polyethylene liners

Hayes Medical (

       Cobalt chrome femoral heads
       Millennium cross-linked polyethylene liners

Plus Orthopedics (

       Cobalt chromium femoral heads

Smith & Nephew (

       Cobalt chrome femoral heads
       Reflection polyethylene liners

       Reflection XLPE (cross-linked polyethylene liners)

Stryker Corporation (

       C-Taper cobalt chrome femoral heads
       LFIT (Low Friction Ion Treatment) cobalt chromium femoral heads
       V40 Vitallium femoral heads
       Crossfire XLPE (highly cross-linked polyethylene liners)
       Trident constrained polyethylene inserts
       Trident Eccentric polyethylene inserts
       X3 polyethylene liners

Zimmer (

       Continuum superpolished 12/14 femoral heads
       6 degree taper cobalt chrome femoral heads
       Versys 12/14 cobalt chrome femoral heads
       Durasul polyethylene liners
       Epsilon Durasul constrained polyethylene inserts
       Longevity highly cross-linked polyethylene liners

00.75  Hip replacement bearing surface, metal-on-metal

Biomet (

       M2a – Magnum System
       M2a- Taper System

DePuy Orthopedics, Inc. (

       Ultamet Metal-on-Metal Articulation

Encore Medical (

       Encore Large Metal/Metal

Wright Medical Technology (

       Conserve Total Hip System with BFH Technology
       Transcend Metal-on-Metal Articulation System

Zimmer (

       Metasul Metal-on-Metal

00.76  Hip replacement bearing surface, ceramic-on-ceramic

CeramTec (

       Biolox delta ceramic femoral heads
       Biolox  forte ceramic femoral heads
       Biolox delta ceramic cup inserts
       Biolox forte ceramic cup inserts

Depuy Orthopedics, Inc. (

       Duraloc Option Ceramic Hip System (using CeramTec components)

Encore Medical (

       Keramos Acetabular System (using alumina ceramic heads and liners)

Hayes Medical (

       Zirconia and alumina ceramic heads

Smith & Nephew (

       Reflection Ceramic Acetabular System

Stryker (

       C-Taper alumina ceramic femoral heads
       V40 alumina ceramic femoral heads
       Trident Ceramic Acetabular System

Wright Medical Technology (

       Lineage alumina ceramic heads
       Lineage ceramic liners
       Transcend Ceramic Hip Articulation System

Effective October 1, 2006, code 00.77 has been added to capture ceramic-on-polyethylene bearing surface. The same brand name ceramic heads listed under 00.76 and the same brand name polyethylene liners listed under 00.74 would apply to this new code.  Smith & Nephew has developed a new hybrid femoral head component made of oxinium, a zirconium metal alloy base treated with oxygen to create a ceramic bearing surface of zirconium oxide.  The oxinium femoral head can be combined with the company's Reflection XLPE to provide another example of a ceramic-on-polyethylene bearing surface.

Coders should bear in mind that the above list is not intended to be exhaustive, but merely to serve as a general reference describing what bearing surfaces are currently available.  In addition to the manufacturers’ websites mentioned above, coders should regularly consult, a site that keeps track of the latest orthopedic components to receive FDA approval or to be involved in ongoing clinical trials. is another valuable website featuring helpful discussions of joint replacement components and the relative benefits and drawbacks of each of the materials currently in use.