Orthopedic Coding Alert

Question: When coding a total hip replacement and adductor tenotomy through a separate incision, do you use 27001-59 or 27000-59?

Becky Williams
Fullerton, Calif.

Answer: CPT offers three options for reporting an adductor tenotomy of the hip. Choosing the appropriate code depends upon the complexity of the procedure.

27000 (tenotomy, adductor of hip, percutaneous, closed [separate procedure]);
27001 (tenotomy, adductor of hip, open); and
27003 (tenotomy, adductor, subcutaneous, open,
with obturator neurectomy)

Code 27000 is used to report the least complex procedure. A small incision or stab incision is made over the origin of the adductor muscles and dissection is carried down to the adductor tendon. A small blade is used to incise and free the tendon. In 27001 and 27003, a longer incision is made extending from the pubis along the inner thigh along the adductor muscle. The adductor tendon is located and incised. In 27003, the obturator nerve then is located and resected.

A total hip arthroplasty and an adductor tenotomy are performed via separate incisions. The surgical approach for a total hip arthroplasty involves an incision along the posterior aspect of the hip. The approach for an adductor tenotomy is via the anterior medial thigh. Because these procedures involve separate incisions, it is appropriate to append modifier -59 (distinct procedural service) to 27000, 27001 or 27003 when this service is rendered during the same operative session as a total hip arthroplasty.

Submit supporting documentation with the claim when this modifier is used because, unfortunately, many insurance carriers do not recognize the -59 modifier. Code 27000 is especially prone to denial when it is billed with another hip procedure due to its separate procedure designation, so be proactive and submit that documentation with the initial claim.