Orthopedic Coding Alert

Search beyond trauma codes for spontaneous and post-THR reductions

CPT® and ICD-10 both offer specific codes depending on the reason for a patient’s hip dislocation. Here’s where to turn when a claim for something other than trauma crosses your desk.

Tip 1: Choose Spontaneous ICD-10 by Type

If the patient has a spontaneous hip dislocation, you should choose among the following CPT® codes:

• 27256 — Treatment of spontaneous hip dislocation (developmental, including congenital or pathological), by abduction, splint or traction; without anesthesia, without manipulation
• 27257 — … with manipulation, requiring anesthesia
• 27258 — Open treatment of spontaneous hip dislocation (developmental, including congenital or pathological), replacement of femoral head in acetabulum (including tenotomy, etc.)
• 27259 — … with femoral shaft shortening.

ICD-10: You should choose your ICD-10 code based on the specific type of spontaneous dislocation. For example, for pathologic hip dislocations, ICD-10 instructs you to use M24.35- (Pathological dislocation of hip, not elsewhere classified…) with the sixth character specifying right, left, » »» » or unspecified (1, 2, 9). And for congenital dislocation, head to Q65.- (Congenital dislocation of hip…).

Tip 2: Post-THR Dislocation Needs 2 Dx

If the dislocation follows a total hip replacement (THR), you should choose either 27265 (Closed treatment of post hip arthroplasty dislocation; without anesthesia) or 27266 (… requiring regional or general anesthesia). Notice that the 27266 descriptor helpfully explains the types of anesthesia that qualify (regional or general).

ICD-10: The appropriate diagnosis codes for these dislocations are:

• T84.02- (Dislocation of internal prosthesis…) with a focus on the sixth character of 0 for right hip or 1 for left hip. You’d add a seventh character for the encounter.
• Z96.64- (Presence of artificial hip joint…) with a focus on the sixth character of 1 for right, 2 for left, 3 for bilateral, and 9 for unspecified.

Caution: You shouldn’t report another dislocation code (S73.01--, Posterior subluxation and dislocation of hip) in addition to these codes.