Orthopedic Coding Alert

If you can’t I.D. type of dislocation, you can’t I.D. repair.

Patients who suffer hip dislocations often fall into one of two categories: traumatic and spontaneous.

When your providers treat patients with hip dislocations, you need to be ready to spring into action with smarts to separate these two types of dislocations, in addition to identifying other types of hip dislocations (such as prosthetic hip dislocation). You’ll also need the wherewithal to select the exact CPT® code necessary for correct coding of the surgery depending on technique, treatment type, and other factors.

Get hip with this expert advice on traumatic and spontaneous hip dislocations.

Separate Traumatic, Spontaneous Dislocations

All coders will first need to know the difference between traumatic and spontaneous hip dislocations.

“A traumatic hip dislocation usually occurs due to a traumatic event like a car accident or a fall. A spontaneous dislocation usually occurs without trauma and many times is recurrent. Hip dysplasia many times is a cause of spontaneous or recurrent dislocations. This is a congenital condition in which the head of the femur and acetabulum are misaligned or do not fit together properly, causing the hip to be unstable.” Wayne Conway CPC, CGSC, COSC, physician coding specialist, senior, at WakeMed Physicians Practice in Raleigh, North Carolina.

According to Jennifer McNamara, CPC,CRC,CPC-I,CGSC,COPC, AAPC Approved Instructor/Professional Recruiter at Ozark Coding Alliance LLC in Bentonville, Arkansas, examples of traumatic hip dislocation would be a “collision in a car accident or a fall from a significant height. Most commonly it is a posterior hip dislocation, where we see the femoral head forced out of the acetabulum toward the rear or the posterior location,” she explains.

On the other hand, McNamara says, examples of a spontaneous hip dislocation include:

• Osteonecrosis, which occurs due to a disruption of blood supply to the femoral head.
• Developmental dysplasia, which occurs when a newborn baby has a dislocated hip.

You’ll code traumatic hip dislocations with a code from the 27250 (Closed treatment of hip dislocation, traumatic; without anesthesia) through 27254 (Open treatment of hip dislocation, traumatic, with acetabular wall and femoral head fracture, with or without internal or external fixation) code set. Code spontaneous hip dislocations with a code from the 27256 (Treatment of spontaneous hip dislocation (developmental, including congenital or pathological), by abduction, splint or traction; without anesthesia, without manipulation) through 27259 (Open treatment of spontaneous hip dislocation (developmental, including congenital or pathological), replacement of femoral head in acetabulum (including tenotomy, etc); with femoral shaft shortening) code set.

E/Ms, Imaging Typically Lead to Dx

In order to diagnose a hip dislocation, the “orthopedic physician will examine the patient and may order imaging tests, like an X-ray, MRI [magnetic resonance imaging], or CT [computed tomography] scan to show the exact position of the dislocated hip, and any additional fractures in the hip or femur,” explains McNamara.

Note: If the surgeon performs an evaluation and management (E/M) service before the surgery, which they almost certainly will, be sure to note the site of service. It might not be your traditional office E/M code (99201 through 99215); some diagnostic E/Ms for this injury will occur in the emergency department (ED), which uses a different code set for E/Ms (99281 through 99285).

Some of the imaging tests your provider might conduct to diagnose hip dislocation include, but are not limited to:

• 73501 Radiologic examination, hip, unilateral, with pelvis when performed; 1 view
• 73502 … 2-3 views
• 73503 … minimum of 4 views
• 73525 Radiologic examination, hip, arthrography, radiological supervision and interpretation
• 73700 Computed tomography, lower extremity; without contrast material
• 73701 … with contrast material(s)
• 73702 … without contrast material, followed by contrast material(s) and further sections
• 73718 Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s)
• 73719 … with contrast material(s)
• 73720 … without contrast material(s), followed by contrast material(s) and further sequences.​

Check Out These Clinical Examples

Here’s an example of a traumatic hip dislocation repair clinical scenario, courtesy of Lynn M. Anderanin, CPC, CPMA, CPPM, CPC-I, COSC, senior director of coding education at Healthcare Information Services in Park Ridge, Illinois.

A patient fell tripping over a rug in their home and landed on their left hip. After the fall, the patient could not bear weight on their left hip. The surgeon saw the patient in an emergency department (ED) setting, where they conducted a three-view hip X-ray and a level-four ED evaluation and management (E/M) service. The patient is diagnosed with left posterior hip dislocation and taken to the operating room (OR). The surgeon performed manipulation to reduce the hip into place, using anesthesia on the patient during the procedure.

Coding: For this encounter, you should report:

• 27252 (… requiring anesthesia) for the hip repair.
• 73502 for the hip X-ray.
• 99284 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. …) for the ED E/M.
• Modifier 57 (Decision for surgery) appended to 99284 to show that the E/M led to surgery.
• S73.015A (Posterior dislocation of left hip, initial encounter) appended to 27252, 73502, and 99284 to represent the patient’s injury.

An example detailing spontaneous dislocation comes from Denise Caposella, CPC, senior consultant at Acevedo Consulting Incorporated in Delray Beach, Florida. In the following passage, she describes the specifics of how your orthopedist might treat an infant with a spontaneous dislocation.

“When the physician treats a spontaneous hip dislocation for an infant, they apply a Pavlik harness, which is a dynamic flexion abduction orthosis. The harness consists of a chest strap, two shoulder straps, and two stirrups. The physician applies the harness with the child in a supine position. The harness holds the hip in 90 to 110 degrees of flexion, and moderate abduction. A mechanical pulley is attached to the patient’s leg with ace wraps securing the material to the skin. Weight is attached to the other end of the pulley to apply the traction force to the hip, allowing a gentle reduction of the hip dislocation. The hip is maintained in approximately 30 to 40 degrees of flexion. Traction time varies from two to six weeks. A splint or hip spica cast is applied to hold the hips in abduction. In an older patient, reduction may be possible by applying skin traction to the affected lower extremity.”

According to Caposella, you’d report 27256 if the surgeon performs this procedure without anesthesia; use 27257 (… with manipulation, requiring anesthesia) if they use anesthesia.