Orthopedic Coding Alert

Core decompressions of the hip are a fairly common orthopedic procedure. Yet no CPT code accurately describes the process. Appropriate reimbursement for the procedure means choosing either an unlisted code or a similar code, depending on carrier preference.

Some coders opt to use 26992 (incision, bone cortex, pelvis and/or hip joint [e.g., osteomyelitis or bone abscess]) for core decompressions. This is an alternative to using an unlisted procedure code (27299, unlisted procedure, pelvis or hip joint) because many providers like to avoid using unlisted codes whenever possible. But 26992 may not accurately describe a core decompression. And while many coders prefer to use an analogous code to an unlisted one, 26992 leaves out both the removal of the necrotic tissue and the bone graft two common elements of the procedure.

Denise Paige, CPC, coding and billing manager for Beach Orthopedic Associates, a four-doctor orthopedic practice in Long Beach, Calif., has reservations about using 26992. I have a surgical cross-coding guide that says 26992 is only for diagnoses that pertain to osteomyelitis and infections (730.xx, osteomyelitis, periostitis, and infections involving bone). Because a core decompression of the hip is usually done for avascular necrosis (733.42, aseptic necrosis of bone; head and neck of femur), a claim using 26992 for a core decompression may get rejected for the wrong pairing of diagnostic and procedural codes. Instead, Paige uses the unlisted code when billing for the procedure.

Two Ways to Code the Decompression

Heidi Stout, CPC, CCS-P, coding and reimbursement manager at University Orthopedic Associates in New Brunswick, N.J., works with 11 physicians representing various orthopedic specialties and has success in coding the core decompression of a hip in two different ways. For carriers that accept an unlisted procedure code, she submits 27299 with the operative report and a letter explaining the surgery in lay terms. If a carrier will not process a claim with an unlisted procedure code and many HMOs will not Stouts surgeons use 27071 (partial excision [craterization, saucerization] [e.g., osteomyelitis or bone abscess]; deep [subfascial or intramuscular]).

When choosing an analogous code like 27071 to report a core decompression of the hip, remember that you are attempting to file the claim with the closest matching code possible without exceeding the procedures worth. Stout is a proponent of 27071 for a core decompression of the hip because the objectives of the two procedures are similar to remove nonviable bone and the surgical techniques are similar.

Coding the Graft

When using 27299, 27071 or 26992, the grafting segment of the surgery may be billable separately depending [...]