Orthopedic Coding Alert

1. The patient suffers three separate dislocation episodes during the postoperative period of a total hip replacement (27130, Arthroplasty, acetabular and proximal femoral prosthetic replacement [total hip arthroplasty], with or without autograft or allograft). The dislocations occur on different days, and a return to the operating room is required in each instance. You would report 27266 (Closed treatment of post hip arthroplasty dislocation; requiring regional or general anesthesia) with modifier -78 (Return to the operating room for a related procedure during the postoperative period) appended for each episode.

2. The patient suffers three separate dislocation episodes after the postoperative period has ended. The dislocations occur on different days, and a return to the operating room is required in each instance. The second and third episodes of dislocation occur during the postoperative period of the surgery for the initial episode of dislocation. Report 27266 for the first episode and 27266 with modifier -78 appended for each subsequent episode.

3. The patient suffers a dislocation episode during the postoperative period of a total hip replacement. The surgeon takes the patient to the operating room and makes two unsuccessful attempts at closed reduction, followed by a third successful attempt. Report 27266 only once, with modifier -78 appended. Unsuccessful attempts at reduction should not be reported separately. However, you could also append modifier -22 (Unusual procedural services) to indicate that the procedure required an unusual amount of intraoperative work.