Orthopedic Coding Alert

 Do you know how the surgeon typically diagnoses hip dislocations?

When a patient dislocates their hip, the road to recovery can be daunting. Coding that road can be a bit stressful for coders, too.

Why? You’ll have to identify the type of dislocation for optimal ICD-10 coding. Further, you’ll need to know how the provider reached the decision to perform surgery. Finally, you’ll code the surgery, which can be represented by a batch of CPT^® codes.

Check out this guide on coding hip dislocation repairs so you can get it right the first time.

Know Dislocation Definitions

For coding purposes, there are two types of hip dislocation: traumatic and spontaneous.

“A traumatic hip dislocation is a condition in which head of femur is forced out of its socket pelvis,” explains Jennifer McNamara, CPC, CRC, CPC-I, CGSC, COPC, AAPC Approved Instructor/ Professional Recruiter at Ozark Coding Alliance LLC in Bentonville, Arkansas. “It would be a major force that would dislocate the hip.”

Examples include a collision in a car accident and a fall from a significant height. “Most commonly it is a posterior hip dislocation, where we see the femoral head forced out of the acetabulum toward the rear or the posterior location,” McNamara says.

On the other hand, spontaneous dislocation “occurs without trauma and many times is recurrent,” says Wayne Conway, CPC, CGSC, COSC, physician coder II at WakeMed Physicians Practice in Raleigh, N.C. “Hip dysplasia many times is a cause of spontaneous or recurrent dislocations. This is a congenital condition in which the head of the femur and acetabulum are misaligned or do not fit together properly, causing the hip to be unstable.”

Look to Imaging Codes on Diagnostic Services

When a patient reports with a dislocated hip, they don’t just head straight to surgery for a procedure. The provider will have to diagnose the condition and make a decision for surgery, which will provide coders with more services to report.

The first code you’ll report is almost certainly an evaluation and management (E/M) service, typically from the 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter.) through 99215 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.) code set—though it could be one of several types of E/M services. If the provider suspects hip dislocation, they will perform further imaging tests in order to confirm the presence/location of the dislocation.

“In order to diagnose and treat a hip dislocation, typically an orthopedic physician will examine the patient and may order imaging tests like an X-ray, MRI [magnetic resonance imaging], or CT [computed tomography] scan,” McNamara confirms.

When the provider performs an imaging test, these are some of the codes you could be dealing with:

• 73501 (Radiologic examination, hip, unilateral, with pelvis when performed; 1 view) through
• 73503 (… minimum of 4 views)
• 73521 (Radiologic examination, hips, bilateral, with pelvis when performed; 2 views) through
• 73523 (… minimum of 5 views)
• 73525 (Radiologic examination, hip, arthrography, radiological supervision and interpretation)
• 73700 (Computed tomography, lower extremity; without contrast material) through 73702 (… without contrast material, followed by contrast material(s) and further sections)
• 73721 (Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material) through 73723 (… without contrast material(s), followed by contrast material(s) and further sequences)

Look at These ICD-10 Codes for Dislocation Dx

When a patient suffers a traumatic hip dislocation, McNamara says you will need to know what precisely was dislocated for many codes, and you will look to the following code sets:

• S73.00- (Unspecified subluxation and dislocation of hip)
• S73.01- (Posterior subluxation and dislocation of hip)
• S73.02- (Obturator subluxation and dislocation of hip)
• S73.03- (Other anterior subluxation and dislocation of hip)
• S73.04- (Central subluxation and dislocation of hip)

For spontaneous hip dislocation diagnosis coding, depend on the documented diagnosis; after all, there are codes for congenital and pathological dislocations, both of which are considered spontaneous. The following code sets will house many of the codes you’ll be including to represent a patient’s spontaneous hip dislocation:

• M24.35- (Pathological dislocation of hip, not elsewhere classified)
• M24.45- (Recurrent dislocation, hip)
• Q65.0 (Congenital dislocation of hip, unilateral)
• Q65.1 (Congenital dislocation of hip, bilateral)
• Q65.2 (Congenital dislocation of hip, unspecified)
• Q65.3- (Congenital partial dislocation of hip, unilateral)
• Q65.4 (Congenital partial dislocation of hip, bilateral)
• Q65.5 (Congenital partial dislocation of hip, unspecified)

Use These Codes for Dislocation Surgeries

Once the surgeon performs the surgery, you’ll represent it with one of the following surgical codes:

• 27250 (Closed treatment of hip dislocation, traumatic; without anesthesia)
• 27252 (… requiring anesthesia)
• 27253 (Open treatment of hip dislocation, traumatic, without internal fixation)
• 27254 (Open treatment of hip dislocation, traumatic, with acetabular wall and femoral head fracture, with or without internal or external fixation)
• 27256 (Treatment of spontaneous hip dislocation (developmental, including congenital or pathological), by abduction, splint or traction; without anesthesia, without manipulation)
• 27257 (… with manipulation, requiring anesthesia)
• 27258 (Open treatment of spontaneous hip dislocation (developmental, including congenital or pathological), replacement of femoral head in acetabulum (including tenotomy, etc))
• 27259 (Open treatment of spontaneous hip dislocation (developmental, including congenital or pathological), replacement of femoral head in acetabulum (including tenotomy, etc); with femoral shaft shortening).