Revenue Cycle Insider

Note conservative Tx attempts before surgery option.

The hip joint is a ball-and-socket joint formed by the joining of two bones — the “ball” is the knobby head of the thighbone, or femur, that fits into the “socket” – a shallow cup-shaped depression in the pelvis called the acetabulum. 

Hip labral tears happen when there is damage to the cartilage that lines the acetabulum. There can be several causes of the labral damage. Most often athletes that participate in ballet, soccer, and golf are prone to this injury due to the repetitive motion (twisting or pivoting) of the sport, wearing down the cartilage over time.

While some labral tears are due to activities, they can also occur due to structural problems such as dysplasia, a condition where hip socket that doesn't fully cover the ball portion of the upper thighbone. Extra bone in the hip, called femoroacetabular impingement (FAI), can also cause pinching of the labrum, which can lead to tearing over time. Labral tears can also be due to trauma from car accidents or contact sports, such as football, causing injury or dislocation of the hip joint for example. 

Read on for advice on coding for hip labral tears.

Surgery as an Option After Conservative Tx Failure

The signs and symptoms of hip labral tears include pain in the hip or groin, often exacerbated when performing daily activities, such as walking, sitting or standing for long periods of time. Other complaints can include a catching or clicking sensation, stiffness, and limited range of motion. 

Conservative treatments can include rest, modified activities, steroid injections, pain medications, and physical therapy. Once these treatments have been exhausted, some patients require arthroscopic surgery to repair or reconstruct the torn labrum. 

The surgical codes you’ll be considering for hip labral tears are:

• 29860 (Arthroscopy, hip, diagnostic with or without synovial biopsy (separate procedure)) 
• 29861 (Arthroscopy, hip, surgical; with removal of loose body or foreign body) 
• 29862 (… with debridement/shaving or articular cartilage (chondroplasty), abrasion arthroplasty, and/or resection of the labrum) 
• 29863 (… with synovectomy) 
• 29914 (… with femoroplasty (ie, treatment of cam lesion)) 
• 29915 (… with acetabuloplasty (ie, treatment of pincer lesion)) 
• 29916 (… with labral repair) 
• 29999 (Unlisted procedure, arthroscopy). This is the suggested CPT code when reporting arthroscopic hip labral reconstruction. 

Do This When Surgeon Performs Repair 

There are two types of hip labrum tear procedures: repair and reconstruction. Repair involves suturing and reattaching the torn labrum to the acetabular rim to restore integrity, function, and stability of the labrum. 

Example: A 16-year-old football player complains of acute right hip/groin pain since kicking a field goal in his last game. The surgeon performs history and physical exam and orders magnetic resonance imaging (MRI) without contrast materials. Findings are consistent with an acute hip labrum tear. The surgeon performs an arthroscopic hip labrum repair and a femoroplasty, given the presence of a cam lesion found intraoperatively.

For this encounter, you would report: 

• 29916 for the arthroscopic hip labrum repair  
• 29914 for the femoroplasty 
• 73721 (Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material) for the MRI 
• Modifier RT (Right side) appended to 29916, 29914, and 73721 to indicate laterality
• The appropriate-level evaluation and management (E/M) code from the 99202 (Office or other outpatient visit for the evaluation and management of anew patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.) 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 total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.) code set 
• Modifier 57 (Decision for surgery) appended to the E/M code to show that the E/M and surgery were separate, significantly identifiable services
• S73.191A (Other sprain of right hip, initial encounter) and M24.851 (Other specific joint derangements of right hip, not elsewhere classified) appended to 29916, 29914, 73721, and the E/M code to represent the patient’s injury.

Do This When Surgeon Performs Reconstruction

Another type of hip labral tear surgery is reconstruction, which involves use of an allograft when the labrum is deficient to restore the seal to the acetabulum. This can involve trimming away of the damaged portion of the labrum and attaching an allograft to the remaining healthy tissue with anchors. 

Tip: During hip labrum reconstruction, a partial or full replacement of the labrum may be performed. 

Example: A 48-year-old ballet dancer presents with a complaint of persistent hip pain and limited range of motion. They have been performing for years and have used conservative measures to manage the ongoing pain. With all conservative measures exhausted, the surgeon orders an MRI without contrast materials and the findings are consistent with a degenerative hip labrum tear. The surgeon performs an arthroscopic hip labrum reconstruction using an allograft due to the poor quality of the remaining labrum.

For this encounter, you would report: 

• 29999 (Unlisted procedure, arthroscopy) for the arthroscopic hip labrum reconstruction using allograft 
• 73721 for the MRI
• Modifier RT (Right side) appended to 29999 and 73721 to indicate laterality 
• The appropriate-level E/M code from the 99202 through 99215 code set
• Modifier 57 appended to the E/M code to show that the E/M and surgery were separate, significantly identifiable services. 
• M24.151 (Other articular cartilage disorders, right hip) appended to 29999, 73721, and the E/M code to represent the patient’s injury.  

Tip: Always check payer policy prior to procedure to determine if the unlisted procedure would be eligible for coverage with the plan. Complete and attach a special letter explaining the use of the unlisted CPT^® code with a comparable CPT^® code description (29916) and relative value unit (RVU) detail asking for an increase in reimbursement of 25 percent due to the surgery’s higher level of technical difficulty. For example, you might mention the meticulous sizing and placement of the allograft. 

Misty Smith, CPC, COSC, CPC, COSC, 
Coder at Bluegrass Orthopaedics in Georgetown, Kentucky