Orthopedic Coding Alert

Total hip replacements (THRs) are one of the most commonly performed orthopedic surgeries. Yet these "routine" procedures are often accompanied by unusual circumstances or conditions such as congenital or developmental hip dislocations or previous hip surgery. Correct coding may involve more than the basic THR code. Knowledge of additional codes and proper modifier usage are critical to reimbursement for these costly reconstructions.
Routine Surgery 
Total or partial hip replacements that occur without complication or additional procedures are coded with one of the following:

27125 hemiarthroplasty, hip, partial (e.g., femoral stem prosthesis, bipolar arthroplasty)

27130 arthroplasty, acetabular and proximal femoral prosthetic replacement total hip replacement), with or without autograft or allograft

27132 conversion of previous hip surgery to total hip replacement, with or without autograft or allograft.
As with most major surgeries, there are related procedures that are considered a normal part of the procedure. According to the American Academy of Orthopedic Surgeons (AAOS) Complete Global Service Data Guide, the following are normally  bundled into the global service package for 27125, 27130 and 27132:

27005 tenotomy, hip flexor(s), open (separate procedure)

27033 arthrotomy, hip, including exploration or removal of loose foreign body

27140 osteotomy and transfer of greater trochanter (separate procedure)

27266 closed treatment of post hip arthroplasty dislocation; requiring regional or general anesthesia

27071 partial excision (craterization, saucerization) (e.g., osteomyelitis or bone abscess); deep (subfascial or intramuscular)

27275 manipulation, hip joint, requiring general anesthesia.
 
 
Also, 27030 (arthrotomy, hip, with drainage [e.g., infection]), 27052 (arthrotomy, with biopsy; hip joint) and 27054 (arthrotomy with synovectomy, hip joint) are used for hip arthrotomies and are included with 27130 and 27132. Code 27125 also includes 27120 (acetabuloplasty).
 
Insertion of femoral components, with or without methyl methacrylate, is also part of the hip arthrotomy.
 
A few procedures often performed with hip arthroplasties are coded separately from the major code:
  
Tenotomy, adductors (codes 27000-27003)
 
Harvesting and insertion of bone graft from distant site (20900, 20902) (for 27130 and 27132 only)   
 
Intertrochanteric/subtrochanteric femoral osteotomy (27165) for 27132 only.
The Not-So-Simple Cases
The above rules apply to routine, uncomplicated hip arthrosplasties. When arthroplasties are nonroutine, coders have to look beyond basic AMA and AAOS rules to determine what they can and can't legitimately bill. Heidi Stout, CPC, CCS-P, coding and reimbursement manager at University Orthopedic Associates in New Brunswick, N.J., provides several examples of hip arthroplasties performed by surgeons that fall outside "the norm" and require special coding consideration.
Example 1: The patient underwent a previous subtrochanteric osteotomy for slipped capital femoral epiphysis. Over the years she developed degenerative joint disease of the hip and required total hip arthroplasty. This case was complicated by significant anatomic abnormalities from her previous osteotomy as well as the presence of previously [...]