2 Costly Hip Coding Mistakes Corrected

hip coding tips

With all the hippity hoppity talk this time of year, I have coding for hips on the brain. Might as well go with it and look into some hip coding tips!

1. Watch for Mod 22 Opportunities With Congenital Cases

If your surgeon performs hip replacement surgery for a developmental or congenital hip dislocation, there’s a decent chance the procedure required enough extra time and work to merit the use of modifier 22 (Increased procedural services).

Don’t assume: The diagnosis alone doesn’t support use of this pay-enhancing modifier. Details of the work and time required beyond the normal range is key to convincing the payer.

In clinical documentation improvement training, inform surgeons about the reimbursement benefits of including a separate paragraph in the op note describing any extra work required for an individual case. Documentation that gives the reviewer clear information will go a long way. For instance, if an underdeveloped acetabulum requires advanced techniques and complex implants during the surgery, the op note should spell that out, identifying how the current case differs from a typical one.

2. Know Your Payer’s Edits and Expectations

You may find that different payers have different rules about which codes may be reported together. Keeping tabs on individual payer edits can be worth the effort if you discover you’ve been ignoring a reportable code.

Example 1: Suppose a patient previously underwent open reduction with internal fixation for a femoral neck fracture. Now, due to nonunion, the patient requires hip hemiarthroplasty with adductor tenotomy and hardware removal. The relevant codes are:

  • 27125 (Hemiarthroplasty, hip, partial (e.g., femoral stem prosthesis, bipolar arthroplasty))
  • 27001 (Tenotomy, adductor of hip, open)
  • 20680 (Removal of implant; deep (e.g., buried wire, pin, screw, metal band, nail, rod or plate)).

Medicare Correct Coding Initiative (CCI) edits prevent payment for 20680 when reported with 27125. But other payers may not apply that edit. You don’t want to miss legitimate opportunities to receive payment for both codes.

Example 2: For a patient who had a subtrochanteric osteotomy in the past and has another as part of total hip arthroplasty, you should report 27132 (Conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft). Should you also report osteotomy code 27165 (Osteotomy, intertrochanteric or subtrochanteric including internal or external fixation and/or cast)? CCI doesn’t bundle the two codes, but some payers may not pay for both on the same claim. Knowing payer rules will help your practice know what to expect as reimbursement.

Bonus tip: When you do report more than one code, know your payer’s rule for modifier 51 (Multiple procedures). Medicare asks you not to use modifier 51, but other payers may require you to use the modifier on codes for additional procedures when you report more than one procedure for a patient on the same date.

How About You?

Have any hip coding success stories to share?

About 

Deborah concentrates on coding and compliance for radiology and cardiology, including the tricky world of interventional procedures, as well as oncology and hematology. Since joining The Coding Institute in 2004, she’s also covered the ins and outs of coding for orthopedics, audiology, skilled nursing facilities (SNFs), and more.

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1 Comments For This Post

  1. jitendra Says:

    great article Deborah..even i have been doing hip coding in the past in interventional radiology, i used to do lot of errors in hip arthrogram and arthrocentesis coding….but errors only help in improving our coding skills…!!

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