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 (biomet.com)

       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. (depuy.com)

       Articuleze cobalt chrome femoral heads

       Enduron polyethylene liners

       Marathon cross-linked polyethylene liners

Hayes Medical (hayesmed.com)

       Cobalt chrome femoral heads

       Millennium cross-linked polyethylene liners

Plus Orthopedics (plusortho.com)

       Cobalt chromium femoral heads

Smith & Nephew (smith-nephew.com)

       Cobalt chrome femoral heads

       Reflection polyethylene liners

       Reflection XLPE (cross-linked polyethylene liners)

Stryker Corporation (stryker.com)

       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 (zimmer.com)

       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 (biomet.com)

       M2a – Magnum System

       M2a- Taper System

DePuy Orthopedics, Inc. (depuy.com)

       Ultamet Metal-on-Metal Articulation

Encore Medical (encoremed.com)

       Encore Large Metal/Metal

Wright Medical Technology (wmt.com)

       Conserve Total Hip System with BFH Technology

       Transcend Metal-on-Metal Articulation System

Zimmer (zimmer.com)

       Metasul Metal-on-Metal

00.76  Hip replacement bearing surface, ceramic-on-ceramic

CeramTec (ceramtec.com)

       Biolox delta ceramic femoral heads

       Biolox  forte ceramic femoral heads

       Biolox delta ceramic cup inserts

       Biolox forte ceramic cup inserts

Depuy Orthopedics, Inc. (depuy.com)

       Duraloc Option Ceramic Hip System (using CeramTec components)

Encore Medical (encoremed.com)

       Keramos Acetabular System (using alumina ceramic heads and liners)

Hayes Medical (hayesmed.com)

       Zirconia and alumina ceramic heads

Smith & Nephew (smith-nephew.com)

       Reflection Ceramic Acetabular System

Stryker (stryker.com)

       C-Taper alumina ceramic femoral heads

       V40 alumina ceramic femoral heads

       Trident Ceramic Acetabular System

Wright Medical Technology (wmt.com)

       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 activejoints.com, a site that keeps track of the latest orthopedic components to receive FDA approval or to be involved in ongoing clinical trials.  Totaljoints.info 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.