Orthopedic Coding Alert

If you miss the difference between 27250 and 27252, you could miss out on almost $600.

Because coding hip dislocations can be disorienting, you are liable to lose out on the reimbursements that your provider deserves. To ethically boost your bottom line, pay attention to these three elements of hip dislocation codes.

First, before learning the tricks to recognizing how these three elements can help you, familiarize yourself with the following codes that deal with hip dislocation. By learning all you can about the codes starting at 27250 and ending at 27254, you will be able to avoid challenging audits and get the most out of your reporting.

Let’s break these codes down:

• 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)

Elements: The major overlapping elements found in these descriptions are:

• anesthesia,
• fixations, and
• type of treatment.

To code properly, think about this as a choose-your-own-adventure; meaning that as you determine which elements pertain to a specific procedure, you will be led to more specific elements that ultimately describe the final code you will want to report.

1. Start by Determining Type of Treatment

This is where you begin to break down your codes into two groups. As you can see, 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. Literally, 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.

So what is a closed treatment? 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.

Once you know which treatment was performed, you can move on.

2. If This Was a Closed Treatment, Determine If Anesthesia Was Required

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. The confusion, however, comes when examining the language for the next code. Notice that code 27252 states that it requires anesthesia. So although you may not encounter this situation clinically, you might be wondering if anesthesia was used, but not necessarily required, should you use this code?

Though different practices approach this question differently, what you as the coder should know is what kind of anesthesia was used (hypothetically). You can assume for these types of procedures that either a general anesthesia or conscious sedation was used. The general rule of thumb is to report 27252 only in circumstances when the orthopedic surgeon uses general anesthesia instead of conscious sedation. However, this code can be used to include conscious sedation if your payer otherwise expresses written permission that the code is appropriate for use during the procedure.

Let’s look at the numbers. Code 27250 is listed at $186.26 payable under the National Physician Rate. Compare that to the 27252 code is listed at $781.66. The numbers speak for themselves. A careful eye and a tenacious coder can get the most out of this procedure by paying attention to the code definitions.

3. If This Was an Open Treatment, Determine If Fixations Were Used

So what do you do if this was an open procedure? You now know that you will be using either code 27253 or code 27254. Note that the dislocation can require varying degrees of care. Take a careful look at the extent of the dislocation before choosing a code.

Here is an easy tip that all coders should keep in mind so you can easily determine if you should use code 27253 or code 27254.

Tip: Carefully look at the language of the code definitions. Although similar, code 27254 requires an internal or external fixation. An internal or external fixation is a device such as plates and screws that stabilize a fracture in an open surgical procedure. These fixations are your dead giveaways to use the latter code. “For acetabular wall fractures, we virtually never use wires and absolutely never use nails,” says Bill Mallon, MD, former medical director, Triangle Orthopedic Associates, Durham, N.C. Code 27253 does not make use any of these tools so if a provider does or does not utilize fixations, you can determine which code to use easily.

One more helpful hint is to keep in mind that you can only report code 27254 with an associated acetabular wall or femoral head fracture. If neither of these indicators are present, look for another code, says Heidi Stout, BA, CPC, COSC, PCS, CCS-P, with Coder on Call, Inc., in Milltown, New Jersey.  

The Step-By-Step Breakdown

Remember: Determine what kind of treatment took place first. After you know this, further specify closed treatments by reviewing the use of anesthesia and further specify open treatments by reviewing the use of fixations. By doing this, your code reporting can earn a provider the maximum it deserves.