Revision THA

Revision THA differs fundamentally from primary THA in scope, complexity, and risk. Rather than replacing a native hip joint, the surgeon must extract one or more existing prosthetic components—femoral stem, acetabular cup, or polyethylene liner—address the underlying failure mode, and reconstruct the joint, often in the setting of bone loss, scarring, and compromised soft tissue. Procedures range from an isolated liner exchange (the least invasive) to full acetabular and femoral component removal with structural bone grafting (the most complex). The extent of revision directly governs ICD-10-PCS and CPT code selection; a partial revision codes differently from a complete revision, and miscoding either direction creates audit exposure.

Common indications include aseptic loosening, instability or dislocation, periprosthetic joint infection (PJI), periprosthetic fracture, implant fracture, and bearing surface failure. When PJI is the driver, documentation must include laboratory and pathology confirmation plus a physician attestation that proceeding to surgery is appropriate—requirements spelled out explicitly in CMS billing and coding guidance for THA (Article A57683). Outcomes after revision THA are measurably worse than after primary THA: re-revision rates in high-volume centers approach 13–14% of index revision cases, with more than 60% of re-revisions occurring within two years of the revision procedure, underscoring the importance of meticulous technique and complete documentation of findings at the time of surgery.

The volume of revision THA in the United States has risen steadily since 1996, a trend expected to accelerate as the pool of primary THA patients grows and lives longer with more active lifestyles. Accurate procedure-level coding is essential not only for reimbursement but also for national registry surveillance through programs such as the American Joint Replacement Registry (AJRR), which relies on ICD-10-PCS trigger codes to capture revision burden data.

CMS explicitly excludes revision THA from the mandatory IQR THA/TKA Patient-Reported Outcomes Performance Measure (PRO-PM), so submitting a revision case as a primary case inflates your eligible denominator and distorts your risk-standardized improvement rate—potentially exposing the hospital to a 25% reduction in the Annual Payment Update across all Medicare Part A claims. In the opposite direction, coding a partial revision (e.g., isolated liner exchange) as a full revision, or omitting the specific component(s) revised, produces incorrect MS-DRG assignment, triggers medical necessity denials, and undermines accurate AJRR registry reporting. Because revision THA carries substantially higher hospital costs than primary THA—often two to three times the resource intensity—undercoding also leaves significant reimbursement on the table and skews internal cost-effectiveness analyses.