Anesthesia Coding Alert

Question: A patient had total hip arthroplasty. Three weeks later, she returned for closed manipulation because of a dislocated prosthesis. Manipulation was unsuccessful, so she had open prosthetic replacement of both components later the same day. How should I code these procedures?

Minnesota Subscriber Answer: This is a complicated scenario, so look at each portion individually. Report the original surgery (total hip arthroplasty) with 01214 (Anesthesia for open procedures involving hip joint; total hip arthroplasty).
 
You should code the attempted manipulation on the patient's return with 01200 (Anesthesia for all closed procedures involving hip joint) and diagnosis 996.4 (Mechanical complication of internal orthopedic device, implant and graft).
 
Report the final procedure (open prosthetic replacement) with 01215 (Anesthesia for open procedures involving hip joint; revision of total hip arthroplasty) and diagnosis 996.4. Some coders recommend 996.77 (Other complications of internal [biological] [synthetic] prosthetic device, implant, and graft; due to internal joint prosthesis), but others disagree with this diagnosis because they believe it represents a problem with the manipulation instead of the prosthesis. If you need a secondary code to explain the exact nature of the mechanical complication, coding experts recommend that you report V43.64 (Organ or tissue replaced by other means; hip) because they say "replaced by other means" includes a hip prosthesis.
 
Because the physician performed two services on the same day (the attempted manipulation and replacement), append modifier -59 (Distinct procedural service) to the second procedure code. File both claims by paper with the operative and anesthesia reports.