Get Paid for Hip Replacement Rehabilitation

Earlier this year, just weeks before his 90th birthday, former President Reagan fell and broke his hip, necessitating an involved surgical process to repair the break and a lengthy regimen of physical therapy. Often, this type of injury results in hip replacement surgery. According to the American Academy of Orthopaedic Surgeons, approximately 310,000 hip replacement operations are performed each year in the United States. Physiatrists, physical therapists and occupational therapists often are called on to help the patient through rehab following hip replacement surgery. Knowing the coding rules for the modalities and services involved can help speed the billing process.

Physiatrists Rehab Billing Guidelines

In many cases, an orthopedic surgeon performs the hip replacement (27132), and a physiatrist is called into the hospital to begin the patients rehabilitation following the surgery. This can confuse billers who are unsure whether the physiatrists care is included in any global fees associated with the surgery. The global period guidelines apply only to the surgeon specifically performing the procedure or any other doctor of the same specialty within his or her group practice, says Carol Pohlig, BSN, RN, CPC, a reimbursement analyst for the office of clinical documentation in the department of medicine at the University of Pennsylvania in Philadelphia. Therefore, an independent physiatrist who is visiting the patient after surgery to coordinate rehabilitation would not have to bill using any separate diagnoses or modifiers, says Pohlig.

The physiatrist would bill for his or her evaluation of the patient following surgery using the subsequent hospital care codes (99231-99233) or inpatient consultation codes (99251-99263), if the visit met all of the requirements of a consultation. (According to CPT 2001, the physiatrist should not bill the initial hospital care codes [99221-99223] unless he or she is the admitting physician and is providing the first hospital inpatient encounter.)

If the surgeon transferred care of the patient to the physiatrist following the surgery for postoperative treatment only, the physiatrist could bill for the procedure using modifier -55 (postoperative management only). The surgeon would bill for his or her portion of the hip replacement using modifier -54 (surgical care only).

If the physiatrist visited the patient after surgery for a reason unrelated to the hip replacement, he or she could bill independently of the surgery. For example, if the patients hip was replaced due to osteoarthritis of the hip (715.15, V43.64), but the physiatrist was visiting the patient to perform a trigger point injection on an unrelated muscle pain in the neck, the visit would be coded 99232 for the inpatient evaluation and 20550 (injection, tendon sheath, ligament, trigger points or ganglion cyst), with the ICD-9 Code 729.1 (myalgia [...]