Orthopedic Coding Alert

Our editors have examined your queries, now we tackle the solutions If you-re puzzled by the hip surgery coding guidelines, let us help you get on the right track. We-ve gathered your top five hip coding questions and put our experts to the test. Review the following questions and answers to get the lowdown on everything from the Girdlestone procedure to resurfacing arthroplasty. 1. Look for THR, Osteotomy Rules Question: Our surgeon performed a subtrochanteric osteotomy three years ago on a patient who suffered a slipped capital femoral epiphysis. Over the years, she developed degenerative joint disease of the hip and required total hip arthroplasty last month. This case was complicated by significant anatomic abnormalities from her previous osteotomy, as well as the presence of previously placed hardware. The surgical procedure included a repeat subtrochanteric osteotomy. Which codes should we bill for this? Answer: You should report 27132 (Conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft) for the patient's total hip replacement. Can you report osteotomy? Although the National Correct Coding Initiative (NCCI) does not bundle 27165 (Osteotomy, intertrochanteric or subtrochanteric including internal or external fixation and/or cast) into 27132, insurers may not pay you for both procedures.
 
-I can't see that they are bundled, so technically both codes could be used, but it seems the primary procedure performed in this case is a conversion of a previous hip surgery to a total hip, and 27132 seems to cover that,- says Denise Paige, CPC, coding and billing manager at Beach Orthopedic Associates in Long Beach, Calif., and the secretary of the AAPC's Long Beach Chapter.
 
-Prior to using those two codes, I would contact the carrier and ask if they would both be payable,- Paige says.
 
If your insurer allows you to report both procedures, you should list your claim as follows:
 - 27132
 - 27165-51 (Multiple procedures). -Another way to code this would be to use modifier 22 (Unusual procedural services) on 27132 for the extra work involved with the abnormalities encountered during surgery, along with an increased fee,- Paige says. 2. Code the Girdlestone With Ease Question: Our surgeon documented a Girdlestone surgery for hip osteoarthritis. Which code should we report? Answer: During the Girdlestone procedure (also known as a resection arthroplasty or an excision arthroplasty), the surgeon removes the femoral head and neck, creating a resection arthroplasty, in which no true hip joint remains.
 
You should report code 27122 (Acetabuloplasty; resection, femoral head [e.g., Girdlestone procedure]) for this surgery.

3. Know Your Options for Hip Resurfacing Question: Our surgeon documented a -Birmingham hip resurfacing surgery,- in which he placed a metal cap over the patient's femoral head and inserted a metal cup into the [...]