Orthopedic Coding Alert

Arthroscopy gets column 2 status with hip procedures.

CCI edits 18.2 effective July 1 to Sept. 30, 2012 bundle some important hip procedures. You will need to ensure you report individually for each procedure keeping in mind the column 2 status for some codes. You will need to append the applicable modifiers to these column 2 codes to earn your payment.

You Can Report Manipulation with Arthroscopy

When reporting the hip arthroscopy with femoroplasty, acetabuloplasty, or labral repair, you will need to distinguish clearly if your surgeon also did manipulation at the hip under general anesthesia. The latest CCI edits 18.2 list CPT® code 27275 (Manipulation, hip joint, requiring general anesthesia) as column 2 code for the following arthroscopy codes:

• 29914 (Arthroscopy, hip, surgical; with femoroplasty [i.e., treatment of cam lesion])
• 29915 (Arthroscopy, hip, surgical; with acetabuloplasty [i.e., treatment of pincer lesion])
• 29916 (Arthroscopy, hip, surgical; with labral repair)

You will need to use appropriate modifier with code 27275 to differentiate between the services.

"Reporting the hip manipulation code in addition to any hip arthroscopy code would only be appropriate if the procedures were performed on opposite sides," says Heidi Stout, BA, CPC, COSC, PCS, CCS-P, Coder on Call, Inc., Milltown, New Jersey and director of orthopedic coding division, The Coding Network, LLC, Beverly Hills, CA.

Also, when reporting both acetabuloplasty and labral repair that your surgeon does, you will need to append modifier to 29916 as this is a column 2 code with 29915. "Per CPT® instructions, it is not appropriate to report labral repair (29916) in addition to acetabuloplasty (29915). The only scenario in which both codes are reportable is when 29916 is performed on one hip and 29915 is performed on the other hip," says Stout.

Append Modifiers To Report Arthroscopy With Hip Procedures

When reporting hip arthroscopy with other hip procedures like acetabuloplasty, you will report arthroscopy, with modifier to identify the separate service. CCI edits 18.2 list codes 29914, 29915, and 29916 as column 2 codes for the following hip procedure codes:

• 27120 (Acetabuloplasty; [e.g., Whitman, Colonna, Haygroves, or cup type])
• 27122 (Acetabuloplasty; resection, femoral head [e.g., Girdlestone procedure])
• 27125 (Hemiarthroplasty, hip, partial [e.g., femoral stem prosthesis, bipolar arthroplasty])
• 27130 (Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft)
• 27132 (Conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft)
• 27134 (Revision of total hip arthroplasty; both components, with or without autograft or allograft)
• 27137 (Revision of total hip arthroplasty; acetabular component only, with or without autograft or allograft)
• 27138 (Revision of total hip arthroplasty; femoral component only, with or without allograft)