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Orthopedic Coding Alert

Plug Reimbursement Leaks by Coding Properly for Hip Conversions

With more than a quarter of a million total hip replacements performed each year, coding for them should be a no-brainer, right?

Wrong. If youre automatically coding 27130 for a total hip replacement when you read those words on the operative report, you might be missing the fact that the procedure was actually a 27132 (conversion of previous hip surgery to total hip replacement, with or without autograft or allograft). Youre also missing out on the extra reimbursement to which your practice is ethically entitled.

This conversion code [27132] is a valuable code that is commonly overlooked, says Christine Banks, RRA, CPC, an orthopedic coding specialist at Massachusetts General Hospital in Boston, MA. It pays more than a total hip because, in a conversion, the surgeon has to remove old hardware from a previous hip surgerynot from a previous replacement. He or she must also deal with any scar tissue and then do the replacement.

Note: The term conversion is not synonymous with revision. Revision occurs when the previous procedure was a total hip replacement and some portion of that specific procedure needs to be redone and thus would be billed with one of the revision codes from range 27134 to 27138.

For example, the Massachusetts Medicare Fee Schedule allows $1,723.78 for a total hip replacement and $1,984.65 for a hip conversion.

Hence, an incorrectly coded total hip replacement for Medicare patient translates into about $261 in lost revenue per case. And it could be more for a non-Medicare patient, points out Barbara J. Cobuzzi, MBA, CPC, president of Cash Flow Solutions, Inc., in Lakewood, NJ.

She compares the relative value units (RVUs) of these two codes to underscore the importance of proper billing: Code 27130 has an RVU of 47.72, while a 27132 has an RVU of 55.11.

Dont Code Only From the Name of the Operation

Banks recalls how she learned this lesson the first time she encountered the conversion codeand almost missed it.

The operative report listed the name of the operation as left total hip replacement, which suggested 27130, she remembers.

But as she read further she discovered the actual procedure was really a conversion.

Note: When conducting an audit, Medicare auditors check the documentation to see what actually occurred during the encounter, rather than merely going by the name of the operation as listed on the operative report. So, to help coders accurately select CPT codes in generalas well as distinguish between a conversion and a [...]