Wiki Hip Revision following periprosthetic fx

[hpycoder]

So after coding Gen Surg for nearly 17 years, I have branched off to ORTHO which is relatively new to me at this point in time. Can anyone w/ortho knowledge guide me in which CPT code to use for L. Hip Revision of the femoral stem and ORIF of periprosthetic fracture performed together. Any help would be greatly appreciated. Thanks!

 

[SavCoder]

So after coding Gen Surg for nearly 17 years, I have branched off to ORTHO which is relatively new to me at this point in time. Can anyone w/ortho knowledge guide me in which CPT code to use for L. Hip Revision of the femoral stem and ORIF of periprosthetic fracture performed together. Any help would be greatly appreciated. Thanks!

For L. Hip revision of the femoral stem look at CPT 27138-LT. Dx would be the complication of the prosthetic joint, for example loosing T84.03- and Z96.64- for presence of artificial hip.

For the ORIF look at CPT 27506-52-LT (Modifier 52 added to 27506 due to both 27506 and 27138 includes IM implant. If only 1 IM implant [femeral stem] placed, then you cant report it twice.) Dx would be the fx code S72.- followed by the periprosthetic fx code M97.0-. And Z96.64- for presence of artificial hip.

Hope this helps

 

[hpycoder]

For L. Hip revision of the femoral stem look at CPT 27138-LT. Dx would be the complication of the prosthetic joint, for example loosing T84.03- and Z96.64- for presence of artificial hip.

For the ORIF look at CPT 27506-52-LT (Modifier 52 added to 27506 due to both 27506 and 27138 includes IM implant. If only 1 IM implant [femeral stem] placed, then you cant report it twice.) Dx would be the fx code S72.- followed by the periprosthetic fx code M97.0-. And Z96.64- for presence of artificial hip.

Hope this helps

Thanks so much for your help!! Have very nice Thanksgiving Holiday ☺

 

[SavCoder]

Thanks so much for your help!! Have very nice Thanksgiving Holiday ☺

Hey hpycoder, I spoke with a senior coder the other day and I told you the incorrect info. Well the explanation needed more detail.

You want to look at how many fixation devices are used.

If only the stem is revised and a longer stem is inserted, only report the revision code with modifier 22 (make sure documentation supports modifier 22). Applying cerclage or wire around the fracture site does not support billing additional fracture care code.

If two different/separate fixation devices applied, for example longer stem revision and separate plate applied to fracture site, then bill both revision code and fracture care code.

Modifier 22 documentation example:
Due to the complexity of the case and the technical skills involved, this significantly increased the physician’s work and operative time. Multiple factors including the patient being obese, the patient having multiple previous surgeries, and abundant scar tissue increased the overall operative time by 25%/50%/75%/100%. The extra time was devoted to the surgical approach, locating the surgical site that has been altered by previous surgeries, and wound closure.

Sorry for the confusion!