Get Paid for Your Hip Procedures With Smart

Orthopedic Coding
By Susan Dooley

Confused about orthopedic coding guidelines for hip surgery? Read on for tips on correct coding for two
types of procedures on this joint.

Look for Rules on Total Hip Replacement and Osteotomy

What happens when a surgeon performs a subtrochanteric osteotomy on a patient who suffered a
slipped capital femoral epiphysis, and then three years later, because the patient developed
osteoarthritis of the hip, the surgeon has to come back and perform total hip arthroplasty?

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com

First, a little background on this condition. Slipped capital femoral epiphysis occurs in adolescents when
the top of the thigh bone, the femoral epiphysis, which is the ball portion of this ball-and-socket joint,
slips out of its place in the acetabulum, or socket. Surgeons sometimes pronounce the acronym for this
condition, SCFE, as skiffy. Because adolescents usually need surgical fixation for this procedure to
prevent the growth plates from moving out of alignment, surgeons often perform a subtrochanteric
osteotomy procedure to repair this condition, which can include screw fixation of the fracture. Later
development of osteoarthritis is a common complication of this condition.

When a patient has already had a subtrochanteric osteotomy in the past, then requires that procedure
again as part of a total hip arthoplasty, what code is appropriate to report? Without a doubt, you would
report 27132 (Conversion of previous hip surgery to total hip arthroplasty, with or without autograft or
allograft.) The question is whether you can report the second occurrence of osteotomy. The Correct
Coding Initiative doesnt bundle 27165 (Osteotomy, intertrochanteric or subtrochanteric including
internal or external fixation and/or cast) into 27132, but insurers may not reimburse for both
procedures. Before you report both codes, check with the payer. If they do allow you to report both
procedures, list them on your orthopedic coding claim this way:

27132
27165-51 (Multiple procedures).

Learn to Code a Girdlestone

In a Girdlestone resection, surgeons remove the femoral head and neck, usually because of cases of
severe hip infection. This means no hip joint remains. Though this is not an everyday procedure, at least
its straightforward to code. For this procedure, you should report 27122 (Acetabuloplasty; resection,
femoral head (eg, Girdlestone procedure).

What About You?

Do you run into these procedures very often? Any tips for successful reimbursement that we forgot? We
love to hear from you!

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The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com

Enterprise Contact:
Name: Sam Nair
Title: Associate Director Enterprise Practice
Email: shyamn@codinginstitute.com
Direct: 704 303 8150

Desk: 866 228 9252, Ext: 4813

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com