Orthopedic Coding Alert

Question: We have been billing out 27299 for total hip resurfacing but then Regence requested we use S2118 instead. A coworker said that we are supposed to use the new S2118 with 27299. But that doesn't really make any sense. It seems like it would be one or the other. Why would we use both?

Utah Subscriber

Answer: Call your carrier, as that does not sound right.

Blue Cross Blue Shield (BCBS) almost always accepts S-codes, such as S2118 (Metal-on-metal total hip resurfacing, including acetabular and femoral components), but you should check the payer's policy regarding S2118. If the payer accepts this code, then that usually means the payer accepts it without the addition of an unlisted code.

Remember: S-codes are private payer codes.Medicare, Medicare, Tricare, CHAMPUS, or CHAMPVA never cover them.

If your Regence payer does not accept S2118, it still may want you to use unlisted code 27299 (Unlisted procedure, pelvis or hip joint) and compare it with a regular CPT code.

Heads up: The American Academy of Orthopedic Surgeons (AAOS) has published its recommendation to code the hip resurfacing procedures as either 27125 (Hemiarthroplasty, hip, partial [e.g., femoral stem  prosthesis, bipolar arthroplasty]) or 27130 (Arthroplasty, acetabular and proximal femoral prosthetic replacement [total hip arthroplasty], with or without autograft or allograft) depending upon whether the procedure has an acetabular component or not. Many commercial health plans have policies published on the procedure. Some of them state which codes they want, while others do not.

Good advice: Some coders have taken the stance that if the payer has a policy indicating that it does cover the procedure but it does not publish which code it wants, you should follow the AAOS recommendation. As always, call your payer to get specifics.