Wiki Periprosthetic proximal femur fracture and/or ORIF

[cmort68]

Good Afternoon,

My physician and I are looking for some advice in regards how to best code this surgical procedure. A little background; our patient had a RT THA a week ago and was ambulating at home, fell and presented to the ER. Diagnosed with a RT periprosthetic proximal femur fracture (M97.01XA) (S72.341A) (Z96.643), patient brought to the OR for fixture of said fracture with cables, but also our physician did a revision right total hip arthroplasty single component (femoral component only). My provider is wondering if we can bill CPT 27138 with an ORIF CPT 27236. There is a CCI edit with those two codes, can we append a modifier -51 to 27236 OR due to the complexity of the surgery add the modifier -22 to CPT 27138 instead for the increased work as noted in the OP note. Would love any guidance provided. Please see OP note below Thanks in advance for any help provided!!!!

 

[nickelclaw]

here is the description to 27236 per the coders desk reference:
27236

The physician directly exposes the femoral fracture for treatment. The patient is placed in a supine position or slightly rolled up onto the other side. A 15 cm incision is made over the lateral hip. The fascia lata is split and the vastus lateralis muscle is detached from the femur. The physician exposes the femoral neck and head. A small periosteal elevator or Kirschner wire is used to reduce (reposition) the fracture. The physician places guide pins through the bone and across the fracture. The guide pins help determine correct screw length. The physician may use cannulated screws or compression hip screws and a plate to achieve internal fixation. In some cases due to the risk of subsequent non-union or avascular necrosis, the physician may replace the femoral head with a femoral prosthesis. The femoral canal is reamed out. A prosthesis of the proper size and length is selected and inserted into the femoral canal. The physician reduces the prosthesis into the acetabulum. The incision is repaired in layers with sutures, staples, and/or Steri-strips.

My thinking is since reason for this was fx I would go with this code instead of the revision. Documentation is there for a 22 don't forget that since this is still in post op to add the 78 too

 

[cmort68]

here is the description to 27236 per the coders desk reference:
27236

The physician directly exposes the femoral fracture for treatment. The patient is placed in a supine position or slightly rolled up onto the other side. A 15 cm incision is made over the lateral hip. The fascia lata is split and the vastus lateralis muscle is detached from the femur. The physician exposes the femoral neck and head. A small periosteal elevator or Kirschner wire is used to reduce (reposition) the fracture. The physician places guide pins through the bone and across the fracture. The guide pins help determine correct screw length. The physician may use cannulated screws or compression hip screws and a plate to achieve internal fixation. In some cases due to the risk of subsequent non-union or avascular necrosis, the physician may replace the femoral head with a femoral prosthesis. The femoral canal is reamed out. A prosthesis of the proper size and length is selected and inserted into the femoral canal. The physician reduces the prosthesis into the acetabulum. The incision is repaired in layers with sutures, staples, and/or Steri-strips.

My thinking is since reason for this was fx I would go with this code instead of the revision. Documentation is there for a 22 don't forget that since this is still in post op to add the 78 too

Awesome, thank you for responding!! I will go with 27236-22-78

 

[nolanspade]

I have been reading these back and forth - trying to decide which side of the boat I'm on. JUST DEVIL's ADVOCATE... CPT, under instructions for use states "Do not select a CPT code that merely approximates the service provided." I agree with @nickelclaw that the code suggest 27236 is REALLY close. But I believe this code is not for a revision. It talks about repairing a fracture so bad with a stem (and this is does not articulate with a prosthetic acetabular component from all I can glean for 27236 specifically), but not revising a previously placed THA femoral component (which would articulate with a prosthetic acetabular component.) So the code says femoral fracture, proximal end, neck, internal fixation or prosthetic replacement. It does not say prosthetic revision. It means replacing real bone with prosthetic (end devils advocate.)

Even the desk reference - though it says "prosthesis of the proper size and length is selected" it does not say the previous hardware is removed. The other option with the CodersDR is to repair the fracture with pins instead. Before this procedure (in the coders reference), it seems the patient has their own broken femoral neck, but after, the patient only has a prosthetic femoral stem and head - not the entire total hip system. I COULD BE WRONG - please comment?