Wiki Revision Hemiarthroplasty Hip

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nmendez1

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I have a patient that had a Hemiarthroplasty on his hip. He then needed a revision of the hemiarthroplasty and the physician replaced the head and stem. This was then coded with the 27138 for the revision of the femoral compartment. The insurance is denying payment saying that the revision was not documented. The report clearly states what was done during the procedure. I do not see any other way to appropriately code this procedure. I understand that the 27138 is for the femoral component of a total hip arthroplasty, but I do not see why this would not be appropriate to use. Should I code this with a removal and then the 27125 again? Any suggestions are appreciated.

Thank you!!
 
What was the reason for the 1st hemi, fracture or other? Was the first case coded 27236 or 27125? If the patient never actually had a total hip arthroplasty then 27138 cannot be coded in my opinion since 27138 is revision of a total. You could consider 27125-22 (extra work of revision versus a "native" joint). You'll probably need to track the 22 to make sure the reimbursement is correct. The removal cpt and replacement can't be coded together I think you'll hit edits also due to the separate procedure designation of the 27090.
I know it doesn't make sense but they are correct technically as the patient never had a total hip in there.
 
amyjph said:
What was the reason for the 1st hemi, fracture or other? Was the first case coded 27236 or 27125? If the patient never actually had a total hip arthroplasty then 27138 cannot be coded in my opinion since 27138 is revision of a total. You could consider 27125-22 (extra work of revision versus a "native" joint). You'll probably need to track the 22 to make sure the reimbursement is correct. The removal cpt and replacement can't be coded together I think you'll hit edits also due to the separate procedure designation of the 27090.
I know it doesn't make sense but they are correct technically as the patient never had a total hip in there.
Click to expand...
The original surgery was a 27125. If it was a 27236 should I bill it as a 27236-22 instead?
 
This is a really good ortho question by the way.
In my opinion, and just looking at this with no op note, I would code it as 27125-22. 27236 is for treatment of a fracture so if that is coded and there is no fracture they would probably deny it again. You would want to read the report and understand why they went back in. Was it displaced implants, painful, non-healing, etc? I have seen cases where the patient had a hemi in place and fell or otherwise injured but in those cases they convert to a total and don't just revise the hemi. It's definitely not a conversion to THA? There could be more to this depending on why they did it. There's no revision hemi CPT so another option is to look at unlisted.
 
amyjph said:
This is a really good ortho question by the way.
In my opinion, and just looking at this with no op note, I would code it as 27125-22. 27236 is for treatment of a fracture so if that is coded and there is no fracture they would probably deny it again. You would want to read the report and understand why they went back in. Was it displaced implants, painful, non-healing, etc? I have seen cases where the patient had a hemi in place and fell or otherwise injured but in those cases they convert to a total and don't just revise the hemi. It's definitely not a conversion to THA? There could be more to this depending on why they did it. There's no revision hemi CPT so another option is to look at unlisted.
Click to expand...
The patient had an infection so the physician went in and cleaned out the joint, removed all the scar tissue, removed the head and stem and replaced with a new bipolar stem and head. There was not and has not been an acetabular component placed on the patient as of yet.
 
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