Orthopedic Coding Alert

Question: One of our surgeons says we should use a total hip code for Birmingham resurfacing even if he doesn’t complete a total hip procedure; another physician says to use an unlisted code. What’s the correct answer?

Washington Subscriber

Answer: Both of your physicians could be right depending on the situation. Check with the payer before submitting your claim following one of these options:

• Report 27125 (Hemiarthroplasty, hip, partial [e.g., femoral stem prosthesis, bipolar arthroplasty]) if the orthopedic surgeon resurfaces only the acetabular or femoral head.
• Report 27130 (Arthroplasty, acetabular and proximal femoral prosthetic replacement [total hip arthroplasty], with or without autograft or allograft) if the surgeon resurfaced both the acetabulum and femoral head.
• Use S2118 (Metal-on-metal total hip resurfacing, including acetabular and femoral components) for hip resurfacing instead of the CPT^® codes for some private payers such as Blue Cross/Blue Shield.

Document: Once you select a code, include “Birmingham” in Box 19 to notify the payer of the type of implant used.