Hierarchy rules (where several procedures occur on the same date)

Debridement, antibiotics and implant retention plus any other code from section Hip revision codes or Excision codes. The latter takes precedence ≥ one-stage revision, part of a two-stage or an excision.

One-stage revision and two-stage revision, the latter takes precedence ≥ two-stage revision. However, to qualify as a two-stage procedure, the code in question must be followed by, or subsequent to, another relevant code on a different date.

2 × DAIR codes are collapsed into one ≥ DAIR.

The ICD-10 code in 3.B.3 (Y831) was used only to corroborate revision procedures and does not indicate a separate procedure if there are other relevant codes present on the same date. If there are no other revision codes, Y831 can be used to indicate a revision.

For debridement, antibiotics and implant retention classification

Any code from section Debridement (owing to deep infection) codes. A DAIR may be carried out as part of another revision procedure on the same date. Where this is the case, the procedure should be classified accordingly (i.e. not as a DAIR alone).

For one-stage revision classification

Any code from section Hip revision codes. To classify as a one-stage revision, the procedure in question must not be followed by any other revision procedure. A patient may have several one-stage procedures.

For two-stage revision classification

We used the following codes to identify clear cases of two-stage operations: Y703 – first stage of staged operation; and Y711 – subsequent stage of staged operation. If these codes are not present, there must be two revision codes on two different dates and the two stages must occur within 180 days of each other. If the subsequent procedure does not occur within this time frame (and Y703/Y711 is not present) the procedures are to be classified as two one-stage operations.

For stage 1-only classification

We used W572* – primary excision arthroplasty of joint NEC; Y037* – removal of prosthesis from organ NOC (not otherwise classified); W394^ – attention to total prosthetic replacement of hip joint NEC; and W954^ – attention to hybrid prosthetic replacement of hip joint using cement NEC (^ may indicate DAIR or part of a two-stage revision, these codes are often followed by another revision code).

For stage 1 or 2 classification

We used any code from Hip revision codes. These are the same codes used to define a one-stage revision and so should only be classified as part of a two-stage revision if the rules for the two-stage revision are satisfied.

For permanent excision classification

We used any code from section Excision codes followed by any other revision or DAIR procedure on a subsequent date. An excision procedure may be performed as part of a two-stage revision. Where this is the case, it should be classified as part one of a two-stage revision, not a permanent excision. DAIR may be performed at the same time as an excision. Where this occurs, patients are to be classified into the permanent excision category.

Hip revision codes

W373 Revision of total prosthetic replacement of hip joint using cement.

W374 Revision of one component of total prosthetic replacement of hip joint using cement.

W383 Revision of total prosthetic replacement of hip joint not using cement.

W384 Revision of one component of total prosthetic replacement of hip joint not using cement.

W393 Revision of total prosthetic replacement of hip joint NEC.

W395 Revision of one component of total prosthetic replacement of hip joint NEC.

W933 Revision of hybrid prosthetic replacement of hip joint using cemented acetabular component.

W943 Revision of hybrid prosthetic replacement of hip joint using cemented femoral component.

W953 Revision of hybrid prosthetic replacement of hip joint using cement NEC.

Y032* Renewal of prosthesis in organ NOC.

Excision codes

Y037* Removal of prosthesis from organ NOC.

W572* Primary excision arthroplasty of joint NEC.

Debridement (owing to deep infection) codes

W801* Open debridement and irrigation of joint.

W802* Open debridement of joint NEC.

W808* Other specified debridement and irrigation of joint.

W809* Unspecified debridement and irrigation of joint.