Orthopedic Coding Alert

Question: I can't tell the difference between codes 27125 and 27236. If a surgeon documents bipolar hip arthroplasty with a femoral neck fracture diagnosis, should we report 27125 or 27236? Our orthopedic surgeons  normally perform these procedures on elderly patients who have fallen and may or may not have had prior hip surgeries.

Missouri Subscriber

Answer: You should report 27236 (Open treatment of femoral fracture, proximal end, neck, internal fixation or prosthetic replacement) when the orthopedic surgeon performs a hemiarthroplasty to treat a patient's fracture.

Alternative scenario: You should instead select 27125 (Hemiarthroplasty, hip, partial [e.g., femoral stem prosthesis, bipolar arthroplasty]) for the rare instances when the orthopedic surgeon performs hip hemiarthroplasty to treat other conditions, such as hip osteoarthritis.

You Be the Coder and Reader Questions were reviewed by Heidi Stout, CPC, CCS-P, coding and reimbursement manager at UMDNJ-RWJ University Orthopaedic Group in New Brunswick, N.J.