jvanek82
True Blue
Good day!
I am looking for an opinion for this surgery. The physician did a total hip revision and also did a prophylactic fixation of the femur. The codes he wants to bill are 27138 and 27187. According to NCCI edits, 27187 bundles with 27138. One coder is saying there is information found that says these codes can be coded for the same site if medically necessary. Based on the documentation in this OP note, would it be appropriate to override this NCCI edit and bill 27187 with the hip revision code?
Patient was identified in the preoperative holding area by name and name tag, and the operative extremity was marked by me. IV antibiotic prophylaxis dosing was confirmed and given. Patient was brought to the operating room by anesthesia and the nursing team. After induction of anesthesia patient was laid lateral decubitus position on an OSI flat table. All bony prominences were well padded. Sterile prepping of the entire leg and draping was performed. A surgical time-out was performed and all were in agreement.
Incision was made utilizing the previous posterior hip incision, extending it a few cm further distally. Dissection was taken to IT band and fascia. IT band and fascia were sharply excised. Hemostasis was achieved throughout the case with electrocautery. Charnley retractor was placed. External rotators and capsule were taken down off the femur as a single sleeve and tagged for later repair. Cultures were taken of capsular tissue and sent for analysis. Extensive debridement of scar tissue was performed around the acetabulum and hip joint to allow for safe mobilization of tissues and bones for retraction throughout the case. The hip was then safely dislocated. The femoral component including head was pulled out of the femur by hand. All fibrous tissue in the femoral canal, around the calcar, and around the greater trochanter was debrided. The acetabulum was then assessed and checked, this was well fixed and the MDM liner was well placed and secure.
Due to patient's poor bone quality as well as the need for tight diaphyseal fit using reamers, the decision was made to perform prophylactic fixation of the femur in an effort to prevent fracture from reaming and impaction of this diaphyseal fit stem. Cables were safely circumferentially passed around the femur at point of maximal stress during reaming. The cable was tightened and clamped.
Retractors were placed to present and exposed the femur for reaming. The femur was then subsequently reamed up to the appropriate size. Fluoroscopy was used to confirm the size of the diaphyseal fit trial stem. Final stem was placed and impacted into place. A trial body and head and neck were placed on the stem, all instruments were removed, and the hip was reduced. The femur was taken through range of motion including flexion and internal rotation, sleeping position, and extension. Hip was found to be stable and clinical leg lengths were appropriate. Position and size of the construct was assessed and confirmed using intraoperative fluoroscopy. Assessment of the femoral height and offset was also performed. The trial components were then removed and the final body and head were impacted into place. The hip was reduced and the final position was again confirmed using intraoperative fluoroscopy. The hip was ranged and good stability was achieved.
The wound was thoroughly irrigated with Betadine and IrriSept followed by sterile normal saline. An injection was performed in the pericapsular and deep tissues with local anesthetic cocktail. 2 g of vancomycin powder placed in the wound. Capsule, external rotators, and gluteus sling was reattached with the femur. IT band was closed with interrupted PDS as well as running Stratafix. Deep layer closed with 1 Stratafix suture and subcutaneous layer closed with 2-0 stratafix suture. A running 3-0 Monocryl was used to approximate the skin edges in a tension-free fashion. Sterile negative pressure wound therapy was applied to the incisions. Patient tolerated the procedure well there were no complications.
Thank you for all opinions and if you have any sources to support the answer that would be appreciated too!!
I am looking for an opinion for this surgery. The physician did a total hip revision and also did a prophylactic fixation of the femur. The codes he wants to bill are 27138 and 27187. According to NCCI edits, 27187 bundles with 27138. One coder is saying there is information found that says these codes can be coded for the same site if medically necessary. Based on the documentation in this OP note, would it be appropriate to override this NCCI edit and bill 27187 with the hip revision code?
Patient was identified in the preoperative holding area by name and name tag, and the operative extremity was marked by me. IV antibiotic prophylaxis dosing was confirmed and given. Patient was brought to the operating room by anesthesia and the nursing team. After induction of anesthesia patient was laid lateral decubitus position on an OSI flat table. All bony prominences were well padded. Sterile prepping of the entire leg and draping was performed. A surgical time-out was performed and all were in agreement.
Incision was made utilizing the previous posterior hip incision, extending it a few cm further distally. Dissection was taken to IT band and fascia. IT band and fascia were sharply excised. Hemostasis was achieved throughout the case with electrocautery. Charnley retractor was placed. External rotators and capsule were taken down off the femur as a single sleeve and tagged for later repair. Cultures were taken of capsular tissue and sent for analysis. Extensive debridement of scar tissue was performed around the acetabulum and hip joint to allow for safe mobilization of tissues and bones for retraction throughout the case. The hip was then safely dislocated. The femoral component including head was pulled out of the femur by hand. All fibrous tissue in the femoral canal, around the calcar, and around the greater trochanter was debrided. The acetabulum was then assessed and checked, this was well fixed and the MDM liner was well placed and secure.
Due to patient's poor bone quality as well as the need for tight diaphyseal fit using reamers, the decision was made to perform prophylactic fixation of the femur in an effort to prevent fracture from reaming and impaction of this diaphyseal fit stem. Cables were safely circumferentially passed around the femur at point of maximal stress during reaming. The cable was tightened and clamped.
Retractors were placed to present and exposed the femur for reaming. The femur was then subsequently reamed up to the appropriate size. Fluoroscopy was used to confirm the size of the diaphyseal fit trial stem. Final stem was placed and impacted into place. A trial body and head and neck were placed on the stem, all instruments were removed, and the hip was reduced. The femur was taken through range of motion including flexion and internal rotation, sleeping position, and extension. Hip was found to be stable and clinical leg lengths were appropriate. Position and size of the construct was assessed and confirmed using intraoperative fluoroscopy. Assessment of the femoral height and offset was also performed. The trial components were then removed and the final body and head were impacted into place. The hip was reduced and the final position was again confirmed using intraoperative fluoroscopy. The hip was ranged and good stability was achieved.
The wound was thoroughly irrigated with Betadine and IrriSept followed by sterile normal saline. An injection was performed in the pericapsular and deep tissues with local anesthetic cocktail. 2 g of vancomycin powder placed in the wound. Capsule, external rotators, and gluteus sling was reattached with the femur. IT band was closed with interrupted PDS as well as running Stratafix. Deep layer closed with 1 Stratafix suture and subcutaneous layer closed with 2-0 stratafix suture. A running 3-0 Monocryl was used to approximate the skin edges in a tension-free fashion. Sterile negative pressure wound therapy was applied to the incisions. Patient tolerated the procedure well there were no complications.
Thank you for all opinions and if you have any sources to support the answer that would be appreciated too!!