ED Coding and Reimbursement Alert

Question: Our physicians often see hip dislocations and it seems like they report a different CPT^® code every time they treat this condition. Is there not a uniform code for this service?

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Answer: Unfortunately, there isn't one specific code that covers all hip dislocations, since these services can vary based on the location of the issue and the type of treatment, as well as whether the doctor used anesthesia for the service or not. The codes that you probably see most often include the following:

• 27250 (Closed treatment of hip dislocation, traumatic; without anesthesia)
• 27252 (...requiring anesthesia)
• 27253 (Open treatment of hip dislocation, traumatic, without internal fixation)
• 27254 (Open treatment of hip dislocation, traumatic, with acetabular wall and femoral head fracture, with or without internal or external fixation)

Each code definition begins by identifying if the procedure is an open procedure or a closed procedure. Knowing the definition of each treatment is half the battle. If you can determine which treatment was performed, you will be able to use codes 27250 or 27252 and for open treatment or codes 27253 or 27254.

A closed treatment refers to the area of a fracture on a dislocated bone. If the fracture site is not surgically opened, then this is what physicians call a closed treatment. Alternatively, an open treatment refers to a procedure when the bone is either surgically opened or the fractured bone is opened remote from the fracture site so an intramedullary nail can be inserted across the fracture site. An ED physician would most likely be reporting a closed treatment code.

Let's say you have determined a closed treatment was performed ― now you must decide whether to use code 27250 or 27252. In order to do this, you must pay close attention to the next element: anesthesia. When deciding which code to use, notice the language of codes 27250 and 27252. Both reference anesthesia. Code 27250 plainly states that no anesthesia was used during the procedure, so you'll turn to 27252 if anesthesia was utilized for the service. Of note, use of moderate sedation is not considered to be anesthesia by CPT® and can be reported separately using the appropriate code from the 99151-99153 (Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer...) or 99155-99157 (Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports...) series depending on whether the sedation was in support of your own procedure or not.