Orthopedic Coding Alert

You will often need to report a number of different additional procedures with hip replacement. The list is exhaustive. We list out the procedures here that are common in any practice and this may be a quick easy reference for you.

Arthrotomy, with drainage, biopsy, or synovectomy, and removal of foreign body is inclusive in the code(s) for hip replacement. So are open tenotomy, osteotomy, manipulation of hip joint, acetabuloplasty, and craterization and saucerization. "Synovectomy, capsulectomy, removal of loose bodies, iliopsoas tenotomy, capsulotomy, excision of osteophytes, hip joint manipulation, arthrotomy, capsular repair/reconstruction, bone grafts are all bundled," says Ruby O'Brochta-Woodward, BSN, CPC, CCS-P, COSC, ACS-OR, compliance and research specialist, Twin Cities Orthopedics, P.A. "This is clearly outlined in the AAOS GSDG, as well as in CCI bundling edits and NCCI guidelines. Coders should review these guidelines for proper coding of all services," says Kristi Stumpf, MCS-P, CPC, COSC, ACS-OR, owner, Precision Coding and Auditing, senior orthopedic coder & auditor, The Coding Network, Maryland.

Here is a list of procedures that are inclusive in the hip replacement codes, 27125-27138.

• 27005 tenotomy, hip flexor(s), open (separate procedure)
• 27030 arthrotomy, hip, with drainage [e.g., infection]
• 27033 arthrotomy, hip, including exploration or removal of loose foreign body
• 27052 arthrotomy, with biopsy; hip joint
• 27054 arthrotomy with synovectomy, hip joint
• 27071 partial excision, wing of ilium, symphysis pubis, or greater trochanter of femur, (craterization, saucerization) (e.g., osteomyelitis or bone abscess); deep (subfascial or intramuscular)
• 27120 acetabuloplasty; (eg, Whitman, Colonna, Haygroves, or cup type)
• 27140 osteotomy and transfer of greater trochanter (separate procedure)
• 27266 closed treatment of post hip arthroplasty dislocation; requiring regional or general anesthesia
• 27275 manipulation, hip joint, requiring general anesthesia.

Management of acetabular fractures is bundled with 27130. Use caution when reporting acetabular fractures, since the standard operative management of the fractures may not necessitate an additional code. However, if you read in the operative note that your surgeon used hardware, you report one of the following codes:

• 27226 open treatment of posterior or anterior acetabular wall fracture, with internal fixation
• 27227 open treatment of acetabular fracture(s) involving anterior or posterior (one) column, or a fracture running transversely across the acetabulum, with internal fixation
• 27228 open treatment of acetabular fracture(s) involving anterior and posterior (two) columns, includes T-fracture and both column fracture with complete articular detachment, or single column or transverse fracture with associated acetabular wall fracture, with internal fixation.

"The revision hip surgeries would also include removal of previously inserted prosthesis, e.g., 27090 (Removal of hip prosthesis; [separate procedure]) and 27091(Removal of hip prosthesis; complicated, including total hip prosthesis, methylmethacrylate with or without insertion of spacer)," says Stumpf.

Stump also lists the following other intraoperative services included in the global service package as per AAOS,

• 1. local infiltration of medication(s), anesthetic, or contrast agent before, during, or at the conclusion of the operation
• 2. surgical approach, with necessary identification, isolation, and protection of anatomic structures, including hemostasis and minor skin scar revision
• 3. obtaining wound specimen(s) for culture
• 4. wound irrigation
• 5. intraoperative photo(s) and/or video recording, excluding ionizing radiation
• 6. intraoperative supervision and positioning of imaging and/or monitoring equipment by operating surgeon or assistant(s)
• 7. insertion, placement, and removal of surgical drain(s), re-infusion device(s), irrigation tube(s), or catheter(s)
• 8. application of initial dressing, orthosis, continuous passive motion, splint, or cast, including traction, except where specifically excluded from global package
• 9. preparation and insertion of synthetic bone substitutes, osteoconductive and osteoinductive agents (eg, hydroxyapatite, calcium phosphates, coral, methylmethacrylate, demineralized bone matrix, bone morphogenetic proteins), except where specifically excluded
• 10. closure of wound and repair of tissues divided for initial surgical exposure, partial or complete
• 11. suture removal by operating surgeon or designee