# Fracture during Total Hip Replacement



## madgejones10 (Aug 2, 2013)

Need help with coding/billing for an intraoperative calcar fracture during a total hip replacement.  

This turned into a 5-1/2 hour surgery.  I am not at all sure how to bill this.  Can anyone help?  

Do I just bill the 27130 (perhaps with a 22 modifier, which really will not pay any extra)  or can I add the calcar fracture???  

PLEASE HELP !!!!

"... the hip was dislocated.  Femoral neck cutting guide was placed and the femoral head was removed.  The piriformis fossa was identified.  The initiator, canal finder, box osteome and broaches up to a size 3 were used.  The calcar reamer was used to ream the calcar.  A medial calcar fracture, which was a 2B fractyure, was noted.  At that point, with difficulty, two proximal cables were placed around the  fracture and the broach.  The broach was then removed.  The leg ws brought back up on the operating table.  A retractor was placed about the acetabulum.  Progressively larger reamers up to a 49 mm reamer were used.  A 50 mm porous coated acetabular component was then packed in 45 degrees of abduction, 20 degrees of anteversion.  Bone slurry was placed on the floor of the acetabulum.  Three screws were placed along with an Apex hole eliminator and polyethylene liner.  When the leg was brought back and when the femoral neck was brought back up to the table, the fracture had shifted,  Because of that, I felt it was less stable.  In initially it was felt that possibly a cemented Summit stem would be appropriate but because of the size of the fracture, it was not felt to be best.  At that point, I elected to put an AML stem in......."


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## tjrice (Aug 2, 2013)

This is an iatrogenic fx. I would use the 22 modifier and include documentation with the claim. Correct coding is your best choice. There also may be a HCPCS code for surgical misadventure as well


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## nyyankees (Aug 2, 2013)

madgejones10 said:


> Need help with coding/billing for an intraoperative calcar fracture during a total hip replacement.
> 
> This turned into a 5-1/2 hour surgery.  I am not at all sure how to bill this.  Can anyone help?
> 
> ...



Did doc cause fracture?


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## bfontaine (Aug 2, 2013)

Can't charge extra if your doctor fractured it during the procedure.  Sorry.


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## madgejones10 (Aug 2, 2013)

Thank you all so much !!!   I appreciate your expertise !!!!


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## melzinser (Aug 5, 2013)

*iatrogenic fracture*

can you give me a reference to show my providers that states you cannot bill for repair of fracture caused during the primary surgery?  they do not believe me...


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## bfontaine (Aug 5, 2013)

2013 NCCI Chapter 1 page 27: Thus, treatment of a complication of a primary surgical procedure is not separately reportable.  

This includes intraoperative hemmorhages as well as intraoperative fractures.


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## melzinser (Aug 6, 2013)

THANK YOU!  they were calling it a coding "urban legend"... now I have proof!


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## melzinser (Aug 6, 2013)

The statement in the NCCI Policy Manual refers to "complications _inherent in an invasive procedure..."  My provider would argue that inherent means intrinsic, or built into the procedure, such as there will always be bleeding when you cut.  But he is arguing that a femoral shaft doesn't always fracture during a hip replacement - it is a factor of the patient's pathology, not the surgeon's fault or technique, and not inherent to the procedure.

Your thoughts?  I need good arguments or documentation to convince him to NOT code for repair of the femoral shaft fracture in addition to the hip arthroplasty._


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## daedolos (Feb 1, 2018)

I wonder what the conclusion of this "urban legend" was.  What if, for example, the patient had very osteoporotic bone and it fractured during the hip replacement?

Peace
?_?


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