27236 vs. 27125 (BIPOLAR HIP REPLACEMENT)-I have many cases

mkbillr

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Hi,

I have many cases in which the following scenario applies:

The patient has a subcapital fracture of the hip (820.09) and is treated with a bipolar hip prosthesis. The regular bipolar prosthesis code (27125) refers you to code 27236 which is for prosthesis following a hip fracture. I use 27236 for this case, however, I was told by our compliance officer that we should have billed 27125 because 27236 is used for replacement of a broken prosthesis. I have read that 27125 is used for planned or routine partial hip replacement for osteoarthritis or disease and therefore does not apply to my scenario. I continue to believe that 27236 is the correct code for my case but would appreciate some feedback from anyone that can help.

Thanks
 
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