Solve the Hip Surgery Denial Dilemma With 3 FAQs
Published on Sat Apr 16, 2005
Modifiers may make the difference for your difficult hip procedure claims If your orthopedic surgeon performs total hip arthroplasty on a patient with a congenital or developmental hip dislocation, you may be entitled to addi-
tional reimbursement.
Our March article "Want to Ace Hip Procedure Coding? Here's How" elicited such a tremendous response from our readers that subscribers sent us dozens of additional hip coding questions. Read on to see how our experts advise tackling your toughest hip coding problems. When Should You Append -22 to THA? Question 1. Every time our surgeon performs a primary total hip arthroplasty on a patient with a congenital or developmental hip dislocation, he thinks we should append modifier -22 (Unusual procedural services) to the claim and request more money. Is this type of surgery generally complicated enough to warrant the modifier and additional reimbursement that the surgeon believes we can collect? Answer: Most likely, yes. "Developmental hip dislocation involves an underdeveloped acetabulum, which necessitates more advanced techniques for reconstruction and oftentimes may require different implants compared to standard hip replacement for osteoarthritis," says Scott C. Wilson, MD, assistant professor of orthopedics at Tulane University School of Medicine in New Orleans.
If your surgeon performs a total hip replacement (27130, Arthroplasty, acetabular and proximal femoral prosthetic replacement [total hip arthroplasty], with or without autograft or allograft) on a patient with developmental hip dislocation, you should check the operative report to determine whether the surgeon noted additional work. If so, you should ask him the percentage of extra work that he performed, and you can then increase your fee by that percentage.
Append modifier -22 to 27130 and send your insurer a letter with your claim, explaining why the physician believes the surgery was more complicated than a normal total hip arthroplasty. In addition, you should send your operative report with the claim.
How Many Codes Describe Hip Joint Debridement? Question 2. Our patient suffered a severe hip joint infection following total hip arthroplasty, so the surgeon performed hip arthrotomy, then debrided and irrigated the wound. Can he bill both 11044 and 27030, or should he just bill 27030? Answer: The answer depends on whether the surgeon debrided bone, or just tissue and/or muscle. If the surgeon does not document bone debridement, you should not report 11044 (Debridement; skin, subcutaneous tissue, muscle, and bone).
Because the surgeon did not document bone debridement, you're left with debridement code choices of 11040-11043. But "the American Academy of Orthopaedic Surgery's Global Service Data indicates that 'debridement, excisional, of soft tissue (e.g., 11040-11043) is included in 27030 (Arthrotomy, hip, with drainage [e.g., infection])," says Tracy E. Wheeler, CPC, coder at Albany Orthopedic Center in Albany, Ga.
When the surgeon performs debridement along with hip arthrotomy [...]
