Orthopedic Coding Alert

Editors Note: Experts in orthopedic coding agree that successful coding in this specialty requires a sound knowledge of medical terminology, the procedures involved and correct CPT codes and diagnostic coding. Our goal is to present actual orthopedic coding cases within the context of the medical terminology and procedures. If you have a case you would like to submit for consideration, please send it via fax, email, or mail.

Case Description

A 74-year-old woman with osteoporosis falls while walking her dog and is taken to the emergency department where she is found to have a subcapital fracture of the right hip. An orthopedic surgeon is called, and the woman is admitted to the hospital and placed in Bucks traction. The next afternoon, she is taken to surgery where an ORIF hemiarthroplasty is successfully performed. The woman is returned to the orthopedic floor of the hospital, but several hours post surgery, in a state of confusion, she attempts to get out of her hospital bed. She crawls past the side rails and slips off the edge of the bed, falling on the repaired hip. Upon examination, she is now found to have posterior dislocation of the prosthesis and is returned to surgery. Under general anesthesia, the orthopedist externally manipulates the prosthesis back into place. The coder receives a surgical report that requires the coding procedures for both the fracture and dislocation.

Terminology and Procedures

The hip fracture, a familiar orthopedic problem, is most often found in white females over 50 years of age. In fact, its interesting to note that 90 percent of all fractures occur in white women aged 70 years and over. Osteoporosis (a general term describing a reduction in bone mass) related hip fractures are a severe economic burden to society, costing an estimated $8 billion per year in the United States.

This case describes a subcapital fracture (820.09), which is a general term to describe a breaking off of the femoral head or top of the femur. The hip joint is a typical example of a ball-and-socket joint, the acetabulum forming the socket and the femoral head the ball. This type of joint combines stability, in all normal positions, with a good range of movement.

Arthroplasty is the general operative procedure that reconstructs both articulating surfaces of a joint. In a total hip replacement (27130), both the ball and socket are completely replaced. In the hemiarthroplasty (27125 or 27236), the focus is on the replacement or reconstruction of the ball even though an acetabular cup may also be placed. Prosthesis is a term used to describe the artificial or replaced part. ORIF is a common orthopedic acronym that stands for open reduction internal fixation.

In a dislocation there is no breaking of [...]