Wiki 27236 vs 27130

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berlew

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Does anyone have any suggestions for me as to which to bill?

I have a patient that has a fractured femoral neck. My doctor did a total hip replacement which includes the femoral component and the acetabular component.
I was reading the description of the codes and the differences I am seeing are, assuming there is a prosthesis being used for the fracture...27236 only replaces the femoral component. 27130 replaces both the acetabular and the femoral component.

My question now is that since this is a fracture, 27236's acceptable diagnosis list is fractures. 27130's acceptable diagnosis list is more along the DJD line of problems. Which would you use?
 
The acetabular replacement component is throwing me

My understanding is that if the prosthetic placement is due to an acute fracture, then you would have to use 27236 (I would use this with a 22 modifier since the acetabulum was replaced as well) (higher RVUs anyways) , but you said there is concern as to wheter or not this is caused by a degenerative process.
I would query the physician and if the fx is due to a degenerative process and not an acute one, I would use the 27130. (Which my understanding with this code can be used if this is a surgical correction method not used to treat an acute fracture).
Stepping out on a limb with this answer, and if I'm wrong, someone please correct me, but this is my two cents.
 
You should use 27130 for THA regardless if it's fracture or not, use 27236 only if it's hemiarthroplasty to treat fracture. This was discussed and clarified by an orthopedic coding consultant Margie Scalley-Vaught at a specialty coding class I attended.
 
KATYA1266 said:
You should use 27130 for THA regardless if it's fracture or not, use 27236 only if it's hemiarthroplasty to treat fracture. This was discussed and clarified by an orthopedic coding consultant Margie Scalley-Vaught at a specialty coding class I attended.
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Thanks for clearing this up! Do you have a website for her so that I can find this information?
 
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