Orthopedic Coding Alert

1 expert coder + 1 surgeon = coding gold.

When you get the chance to pick the brain of someone who’s been performing orthopedic surgeries for nearly two decades, you do it.

That’s what we were able to do thanks to Christa DiCiaccio, CPC, coding specialist I at CaroMont Medical Group in Gastonia, N.C. She spoke with one of her surgeons, who specializes in hip replacement surgery. “I did sit down with him and ask him [about hip replacements], and here is the information he gave me,” DiCiaccio explains. “He is a great guy and has been doing this for 18 years, so he is very knowledgeable.”

Take a look at what the expert coder got out of the expert surgeon.

Check Out Clinical Breakdown of 27125, 27130

DiCiaccio was able to speak to the surgeon about two procedures specifically: 27125 (Hemiarthroplasty, hip, partial (eg, femoral stem prosthesis, bipolar arthroplasty)) and 27130 (Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft).

27125: “We do this all the time,” DiCiaccio says. “The patient’s acetabulum remains intact, and we are only replacing the femoral head with a ball-type prosthesis that fits inside the patient’s native acetabulum. For example, when an elderly patient has fallen and has fractured the femoral head.” This procedure is similar to 27236 (Open treatment of femoral fracture, proximal end, neck, internal fixation or prosthetic replacement), which you’d report when the provider performs a hemiarthroplasty to treat a hip fracture.

27130: This code is “for the total hip replacement includes replacing the ball and the socket, or acetabulum. The socket is replaced with a cuplike prosthesis and the ball is replaced just like in code 27125.

Documentation alert: “My surgeon stated that it should be very clear in the operative note whether the procedure is for a total or a partial hip replacement, with the words ‘total’ or ‘partial’ being documented specifically. He says there should be no need for clarity, that the documentation alone should be a clue.”

So if you don’t have definite documented proof about the extent of a hip replacement, be sure to run it by the surgeon again to get the info.