Wiki Total hip with an ORIF


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If our physician did a total hip replacement for fracture and then secured the fracture with Dall-Miles cables, we can only bill the total hip 27130 correct?
If the preoperative diagnosis and reason for surgery was treatment of a proximal femur fracture, most likely a variety of displaced femoral neck, then your physician did an Open Treatment of a Femoral Neck Fracture with a Prosthesis, 27236. Although the prosthesis usually used is a Femoral Head Prosthesis (Unipolar or Bipolar), there are times when a Total Hip Arthroplasty (THR) is done for these fractures. There is support for this in the Orthopedic Literature as an effective and satisfactory surgical treatment for Femoral Neck Fractures in some situations/circumstances, but it is still Fracture Care. The code 27236 just says "Internal Fixation or Prosthetic Replacement," and does not differentiate between the traditional Femoral Head Prosthesis or a Total Hip Prosthesis. In other words, a prosthesis is a prosthesis. The use of the Cables to supplement the Prosthesis would also be included in this code as Internal Fixation. Also, in the follow up care for the patient, the primary diagnosis code would be for the fracture, not follow up for a THR (i.e. the use of Z Codes, which don't apply to Trauma/Fracture care follow up).

Respectfully submitted, Alan Pechacek, M.D.