I am new to orthopedic billing and I am afraid that I may have been coding the hip hemiarthroplasty procedures incorrectly and I am seeking help and advice. I was using code 27125 since the description of that code is hemiarthroplasty, hip, partial. For total hip replacements I am using 27130. I am worried now that for the hemiarthroplasty I should be using code 27236? Can someone offer guidance on the differences in the operative technique that would help me to determine which code is correct? Below is one of my examples. Thank you in advance for any help!
Preoperative Diagnosis
Right displaced femoral neck fracture.
Postoperative Diagnosis
Right displaced femoral neck fracture.
Operation
Right hip hemiarthroplasty. Physician directed fluoroscopy less than 1 hr.
Findings
Intraoperatively patient was found to have a comminuted displaced right femoral neck fracture. There was slight posterior comminution of the femoral neck noted. There was no obvious propagation into the femoral calcar. No obvious bony lesions noted.
Technique
The patient was seen in the preoperative holding area, the right hip was marked, and consent was obtained. All questions were answered to their satisfaction preoperatively. The patient was transferred to the operative suite and given the benefit of general anesthesia by the anesthesia team. They were then transferred to the operative bed where well-padded boots were applied and properly secured to the bed with all bony prominences well padded. They were appropriately placed against the perineal post. The right lower extremity was then prepped and draped in a normal sterile fashion. A time-out was performed all those in attendance were in agreement with the correct operative site and procedure to be performed.
Ten blade scalpel used to incise the skin for an anterior intermuscular approach. Electrocautery was used for hemostasis and dissection to the level of the tensor fascia lata. The Bovie was then used to violate the tensor fascia lata fascia and curved Mayo scissors were used to extend our incision through the fascia. Blunt finger dissection was then used to elevate the muscle from the fascia until the anterior hip capsule was encountered. The circumflex vessels were then cauterized with the AquaMantys and cut with the Bovie. The rectus femoris was elevated from the anterior capsule utilizing a blunt Cobb elevator and a number 9 retractor was placed in the anterior acetabulum. Appropriate retractors were placed on the superior and inferior neck and the capsulectomy was performed with the Bovie. At this point I visualized the femoral neck fracture. An oscillating saw was used to make a femoral neck cut about a fingerbreadth above the lesser trochanter. The femoral neck and head were removed and measured on the back table. Trial replacement head sizes were used until the final size 47 mm was selected. The retractors were removed and the hip was externally rotated to approximately 110°.
The 8 retractor was placed medially on the femur and the inferior and posterior capsule were reflected off of the proximal femur utilizing the Bovie. The 5 retractor was placed lateral to the greater trochanter and the Bovie was once again used to reflect the capsule from the proximal femur where needed to expose appropriately for preparation of our stem. The hydraulic femoral elevator was use to help with exposure of the proximal femur. A box osteotome was used to gain access to the canal followed by a rat-tail rasp. Sequential broaching was then performed until the final stem was secured. Leaving the trial stem in place multiple trial reductions with different neck lengths were performed to verify reduction, leg length, and stability. The trial implants were removed and once the final implant sizes were selected the femoral canal was thoroughly irrigated with sterile saline. The final implant was impacted into place and found to be stable at the appropriate depth. The final bipolar shell was malleted to engage the Morse taper on the stem. Final reduction was performed and the hip was placed through internal and external rotation with stability confirmed. Fluoroscopy was used to verify final implantation and images were saved to the chart. The wound was thoroughly irrigated with sterile saline, topical vancomycin powder 1 g was placed in the wound, and the fascia was reapproximated with a running barbed #1 Strata-fix suture. Skin was reapproximated with a 2 0 Vicryl in a subcuticular inverted fashion followed by subcuticular running 3 0 Monocryl. Prineo skin dressing was applied followed by a sterile island dressing.
All needle and scrub counts were correct at the end of the case x2. Patient was awoken from anesthesia and transferred to the PACU in stable condition.
*
Implant: Biomet hemi hip system with a size 11 high offset echo micro plasty stem, a 47 mm R com acetabular cup with a standard 28 mm head component.
Preoperative Diagnosis
Right displaced femoral neck fracture.
Postoperative Diagnosis
Right displaced femoral neck fracture.
Operation
Right hip hemiarthroplasty. Physician directed fluoroscopy less than 1 hr.
Findings
Intraoperatively patient was found to have a comminuted displaced right femoral neck fracture. There was slight posterior comminution of the femoral neck noted. There was no obvious propagation into the femoral calcar. No obvious bony lesions noted.
Technique
The patient was seen in the preoperative holding area, the right hip was marked, and consent was obtained. All questions were answered to their satisfaction preoperatively. The patient was transferred to the operative suite and given the benefit of general anesthesia by the anesthesia team. They were then transferred to the operative bed where well-padded boots were applied and properly secured to the bed with all bony prominences well padded. They were appropriately placed against the perineal post. The right lower extremity was then prepped and draped in a normal sterile fashion. A time-out was performed all those in attendance were in agreement with the correct operative site and procedure to be performed.
Ten blade scalpel used to incise the skin for an anterior intermuscular approach. Electrocautery was used for hemostasis and dissection to the level of the tensor fascia lata. The Bovie was then used to violate the tensor fascia lata fascia and curved Mayo scissors were used to extend our incision through the fascia. Blunt finger dissection was then used to elevate the muscle from the fascia until the anterior hip capsule was encountered. The circumflex vessels were then cauterized with the AquaMantys and cut with the Bovie. The rectus femoris was elevated from the anterior capsule utilizing a blunt Cobb elevator and a number 9 retractor was placed in the anterior acetabulum. Appropriate retractors were placed on the superior and inferior neck and the capsulectomy was performed with the Bovie. At this point I visualized the femoral neck fracture. An oscillating saw was used to make a femoral neck cut about a fingerbreadth above the lesser trochanter. The femoral neck and head were removed and measured on the back table. Trial replacement head sizes were used until the final size 47 mm was selected. The retractors were removed and the hip was externally rotated to approximately 110°.
The 8 retractor was placed medially on the femur and the inferior and posterior capsule were reflected off of the proximal femur utilizing the Bovie. The 5 retractor was placed lateral to the greater trochanter and the Bovie was once again used to reflect the capsule from the proximal femur where needed to expose appropriately for preparation of our stem. The hydraulic femoral elevator was use to help with exposure of the proximal femur. A box osteotome was used to gain access to the canal followed by a rat-tail rasp. Sequential broaching was then performed until the final stem was secured. Leaving the trial stem in place multiple trial reductions with different neck lengths were performed to verify reduction, leg length, and stability. The trial implants were removed and once the final implant sizes were selected the femoral canal was thoroughly irrigated with sterile saline. The final implant was impacted into place and found to be stable at the appropriate depth. The final bipolar shell was malleted to engage the Morse taper on the stem. Final reduction was performed and the hip was placed through internal and external rotation with stability confirmed. Fluoroscopy was used to verify final implantation and images were saved to the chart. The wound was thoroughly irrigated with sterile saline, topical vancomycin powder 1 g was placed in the wound, and the fascia was reapproximated with a running barbed #1 Strata-fix suture. Skin was reapproximated with a 2 0 Vicryl in a subcuticular inverted fashion followed by subcuticular running 3 0 Monocryl. Prineo skin dressing was applied followed by a sterile island dressing.
All needle and scrub counts were correct at the end of the case x2. Patient was awoken from anesthesia and transferred to the PACU in stable condition.
*
Implant: Biomet hemi hip system with a size 11 high offset echo micro plasty stem, a 47 mm R com acetabular cup with a standard 28 mm head component.