I think I would need to see an op note. However, this is not normally seen, these are exceptions. Seems it would be for patients w/ osteoporosis or osteopenia who are undergoing THA (but the THA is not due to a fall/fracture)? These are primary THA not revisions, right? If they are doing it at the neck and there is a supporting diagnosis,
I would probably say yes. It's a separate reason/procedure and not normally included in a THA. The only time I have coded 27495 in my past coding life was for impending fractures due to lesions and metastatic bone cancer, etc.
If there was an iatrogenic fracture, fixing that cannot be billed separately, but that is not the definition of prophylactic so the 27495 would not apply anyway at that point.
The places you can check are NCCI Manual (quickly searching I did not find any specifics other than the general intraoperative complication stuff), CPT Assistant, AHA Coding Clinic, the AAOS Complete Global Service Data (
I checked an old one, none of these are considered included together). I did a quick P2P edit check and didn't see any edits.
In this case, if you were to check all of those references I listed, I think I would tend to agree with your docs. You might run into health plan issues depending on where you are billing it to. You would want to check payer policies too.
Dr. Raizman will most likely chime in.
Edited following confirmation from Dr. Raizman that it is not separately billable. See current year GSD.
There's the answer, can't do together. (In my defense I did say I checked an old one) LoL.