Orthopedic Coding Alert

Additional procedures that you report determine your reimbursement.

A simple hip replacement may look easy to report, but there could be hidden factors such as additional procedures bundled in the hip replacement code(s) that could complicate your code selection. Read on to know what to report and what to not report when you're coding hip replacements. (Watch for Part 2 in the next Orthopedic Coding Alert where we'll cover other hip replacement coding challenges, including grafts, femoral blocks, and resurfacing.)

Look For the Component Replaced

The first thing you should look for when reporting the hip replacements is what component of the hip your surgeon is replacing or revising. Your surgeon may replace the femoral head or both the femoral head and the acetabulum. When only the femoral head is being replaced with stem insertion, you report a hemiarthroplasty with 27125 (Hemiarthroplasty, hip, partial [eg, femoral stem prosthesis, bipolar arthroplasty]).

When your surgeon replaces both, the femoral head and the acetabulum, you report 27130 (Arthroplasty, acetabular and proximal femoral prosthetic replacement [total hip arthroplasty], with or without autograft or allograft) for the total hip replacement (THR). Look specifically at whether your surgeon is doing the hemiarthroplasty to treat a fracture. If so, you report 27236 (Open treatment of femoral fracture, proximal end, neck, internal fixation or prosthetic replacement).

Similarly, when reporting the revisions of a total hip arthroplasty, you report 27137 (Revision of total hip arthroplasty; acetabular component only, with or without autograft or allograft) if your surgeon is revising the acetabulum and 27138 (Revision of total hip arthroplasty; femoral component only, with or without allograft) if your surgeon is revising only the femoral component. When your surgeon revises both the components, you report, 27134 (Revision of total hip arthroplasty; both components, with or without autograft or allograft).

When your surgeon performs a THR in a joint that has earlier been operated on but not for a total hip replacement, you report 27132 (Conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft).

Example 1: Your surgeon may be doing a THR in a patient with degeneration of the hip joint who developed a difference in limb length due to a malunion after correction of a hip fracture she sustained two years ago for which a subtrochanteric osteotomy was done.

In this case, you should carefully read the operative note to confirm that a previous surgical procedure was recorded, and you report the THR with code 27132. "Any prior hip surgery (other than prior THA) requiring a skin incision would qualify the total hip replacement as a "conversion" procedure Per CPT® Assistant December 2008," says Kristi Stumpf, MCS-P, CPC, COSC, ACS-OR, owner, Precision Coding and Auditing, senior orthopedic coder & auditor, The Coding Network, Washington. "Any hardware removal from the prior surgery is included in 27132. CPT® Assistant December 2008 goes on to state that modifier 22 (Increased Procedural Services) can be utilized for significant increased complexity. Coders should keep in mind that increased complexity was included in the RVU calculations for 27132; there would need to be significant increased complexity, above and beyond simple hardware removal and release of adhesions to support use of the 22 modifier."

Example 2: If you read that your surgeon is doing a THR for a patient who had undergone a femoral head resurfacing (FHR) 10 years ago for an intracapsular transcervical fracture, you confirm a past hip surgery and report 27132.