Orthopedic Coding Alert

Understand what FHR involves and when patients benefit.

An initial femoral head resurfacing (FHR) procedure involves only the femoral head and not the acetabular socket of the hip joint. The surgeon mills the femoral head and implants a metal hemisphere over the bone that exactly matches the size of the original femoral head.

FHR helps "buy time" for patients whose disease or degree of progression doesn't merit total hip replacement (27130, Arthroplasty, acetabular and proximal femoral prosthetic replacement [total hip arthroplasty], with or without autograft or allograft).

This is especially true for younger patients because femoral head resurfacing preserves more bone stock for possible later revisions.

Judy Larson, CPC, billing manager for Rockford Orthopedic Associates in Rockford, Ill., shares a few advantages of choosing FHR:

• Patients are likely to recover a natural gait

• The larger size of the implant (ball) reduces the risk of dislocation

• The femoral head/canal is preserved

• There's no associated femoral bone loss with future revision

• Patients can experience less thigh pain because hip stress transfers in a natural way along the femoral canal and through the femur's head and neck.

The metal head used during FHR will wear out the socket over time, however, and the patient will need total hip replacement.

Once the patient reaches the point of total hip replacement you'll code the new procedure as a conversion with 27132 (Conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft), says Heidi Stout, CPC, CCS-P, director of orthopedic coding services at The Coding Network.