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Orthopedic Coding Alert

Coding Triple Hip Reduction Often Requires Modifiers

Prosthesis dislocations during global can be payable, if you know how to bill

If your patient's hip prosthesis dislocates following arthroplasty, you usually can bill for the dislocation treatment, but don't forget your modifiers.
A subscriber submitted the following question to Orthopedic Coding Alert: "My physician reduced a dislocated total hip prosthesis twice after the initial reduction, for a total of three reductions. Medicare denied the second and third reductions, despite the fact that I appended a modifier. What did I do wrong?"

The answer depends on when the surgeon performed the subsequent reductions. "The documentation should reflect whether your surgeon performed three separate reductions for three episodes of dislocation, or if it took three attempts during one operative session to achieve a successful reduction," says Randall Karpf, president of East Billing in East Hartford, Conn. You should also determine whether the patient was in the global period when the surgeon performed the subsequent procedures.
If you find yourself in this situation, you should choose from one of two coding scenarios:

Coding Solution #1: The patient has three separate dislocation episodes during the postoperative period of a total hip replacement (27130, Arthroplasty, acetabular and proximal femoral prosthetic replacement [total hip arthroplasty], with or without autograft or allograft). The dislocations occur on different days, and the surgeon returns the patient to the OR in each instance.
You should report 27266 (Closed treatment of post hip arthroplasty dislocation; requiring regional or general anesthesia) with modifier -78 (Return to the operating room for a related procedure during the postoperative period) appended for the first episode.

You should bill 27266 with modifier -76 (Repeat procedure by same physician) appended for each of the two subsequent procedures.

Coding Solution #2: The patient has a dislocation episode during the postoperative period of a total hip replacement. The surgeon takes the patient to the OR and makes two unsuccessful attempts at closed reduction, followed by a third successful attempt.

Report 27266 only once, and append modifier -78. You should not separately report unsuccessful attempts at reduction. But you should append modifier -22 (Unusual procedural services) to indicate that the procedure required an unusual amount of intraoperative work.

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