# Need help!!!



## Bella Cullen (Nov 29, 2011)

Hello, 
I was wondering what CPT code do any of you use for *Hip Core Decompression*???? The dx is necrosis of the bone. (733.40)

Appreciate any help, 
Thanks


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## TonyaMichelle (Nov 29, 2011)

Hip core decompression is done when the bone of the hip becomes necrotic due to lack of blood flow and the surgeon drills a hole into the femoral neck to drill out the necrotic area of the bone. 

So depending on what the op report says, I would use 27161(Osteotomy, femoral neck (separate procedure). 

I really need to see the op report for a more definitive answer, but nevertheless, I believe that this is the correct CPT section that pertains to that category of procedures.


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## primrose1 (Nov 30, 2011)

We use 27299 for an unlisted procedure of the hip


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## maryanneheath (Dec 1, 2011)

I have a surgeon who does hip core decompression and he chooses to use CPT 27187, you might want to check your operative report and see if this fits.


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## scooter1 (Dec 2, 2011)

Hip Core decompression

Hip core decompression is used for avascular necrosis of the femoral head and involves removing a plug of bone from the involved area. It is applicable to patients with a mild to moderate degree of involvement that has not yet progressed to collapse. Because the procedure creates a hole in the bone, increasing stress on the proximal femur, six weeks of protected weightbearing is often necessary to avoid fracture.

Currently, no CPT code exists that describes the full work performed in a hip core decompression. The American Medical Association's CPT guide states that this procedure should be reported using the unlisted code, 27299. There are several codes, however, that could represent components of this procedure. These include:

• 27071â€”Partial excision (craterization, saucerization) (eg, osteomyelitis or bone abscess); deep (subfascial or intramuscular)â€”which describes removal of the necrotic (dead) femoral head (of the hip socket) with special devices, creation of a core decompression area and obtaining autogenous cancellous bone. 

• 20955â€”Bone graft with microvascular anastomosis; fibulaâ€”which represents the vascularized fibular graft procedure in which the fibula is harvested from the leg with its small attached blood vessels and transferred to the hip where microvascular anastomosis of four vessels is performed.

• 27170â€”Bone graft, femoral head, neck, intertrochanteric or subtrochanteric area (includes obtaining bone graft)â€”which covers placement/attachment of the fibular bone graft and cancellous bone graft into the cavity created in the femoral head.

The AAOS Coding, Coverage and Reimbursement Committee has also recognized that code 20225â€”Biopsy, bone, trocar, or needle; deep (eg, vertebral body, femur)â€”could be used again depending on what is actually being performed and documented (April 2004).

Many of these codes can be considered inclusive and/or bundled in the other codes under the Correct Coding Initiative. Under CPT guidelines, however, an unlisted code should be reported instead of codes that approximately represent the services rendered. In your cover letter for reimbursement purposes, you can liken the procedure to one or more of the codes listed above, depending upon the specific interventions performed.


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## Bella Cullen (Dec 5, 2011)

thanks for your input, i will use unlisted hip.


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