Orthopedic Coding Alert

Make sure these ICD-9 codes are on your list of common hip ailments If your orthopedist is treating hip conditions, you need to know the pathology to properly assign diagnosis codes to prove medical necessity -- or you could be facing more than your fair share of denials.

The hip is one of the largest ball-and-socket joints and one of the most stable joints in the body, but over time it can be subject to wear-and-tear and injuries that can cause intense pain, says Leslie Follebout, CPC, coding department supervisor at Peninsula Orthopaedic Associates in Salisbury, Md. In addition, patients may suffer from hip injuries from falling or playing sports and require an orthopedist's intervention. Remember Your ICD-9 Coding Rules When your orthopedist meets with a patient, you should pay particular attention to her documentation of the patient's condition to assign the correct diagnosis codes, says Susan Vogelberger, CPC, CPC-H, CMBS, CCP, owner of Healthcare Consulting & Coding Education LLC in Boardman, Ohio.

For example, you would code an acute injury very differently from a chronic condition. According to ICD-9 guidelines, if your physician describes the same condition as both acute (or subacute) and chronic, and separate subentries exist in ICD-9's index at the same indentation level, you should code for both and sequence the acute (or subacute) first. The physician will determine the acute versus chronic diagnosis and should clearly document it in the patient's record, Vogelberger adds.

Be on the lookout: Terms you should watch for that indicate a chronic condition include the following:

- Degenerative

- History of

- Continued to recur

- Condition continues despite conservative management/measures

- Unresponsive to therapy

- Progressive

- Failure to improve

- Old. For example: To show how acute versus chronic affects your code selection, you would choose 843.9 (Sprains and strains of hip and thigh; unspecified site of hip and thigh) for an acute hip sprain or strain and 718.95 (Unspecified derangement of joint; pelvic region and thigh) for a chronic condition, Vogelberger says. Arthritis Can Support Several Treatment Options Although rheumatoid arthritis (714.0) can affect the hip, most hip arthritis patients suffer from osteoarthritis (715.9x). These patients may have stiffness, pain, limited range of motion, and sometimes a complete inability to move the hip joint. Physicians use physical exams and x-rays to diagnose hip arthritis.

Surgeons usually prescribe conservative treatments, such as nonsteroidal anti-inflammatory drugs (NSAIDs), rest, physical therapy and occasionally injections, to initially alleviate the patient's symptoms.

When conservative treatments fail to address these symptoms, there are a number of surgical interventions that orthopedists can perform to repair damage done by hip arthritis, including hemiarthroplasty (27125, Hemiarthroplasty, hip, partial [e.g., femoral stem prosthesis, bipolar arthroplasty]), the Girdlestone procedure (27122, Acetabuloplasty; resection, femoral head [e.g., Girdlestone procedure]) or a total hip replacement (27130, Arthroplasty, acetabular and proximal femoral [...]