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August 30, 2010

Coding for Joint Replacement
For The Record
Vol. 22 No. 16 P. 28

Joint replacement surgery involves removing a diseased joint and replacing it with an artificial prosthetic joint with the goal of relieving pain and increasing mobility and function. The hip and knee joints most commonly require replacement.

Total hip replacement is classified to code 81.51, and partial hip replacement goes to code 81.52. A total hip replacement involves replacing the femoral head and the acetabular articular surface. A partial hip replacement, also documented as hemiarthroplasty, involves replacing only the femoral head. A bipolar hemiarthroplasty is a specific form of hemiarthroplasty in which a femoral prosthesis is used with an articulating acetabular component, but the acetabular cartilage is not replaced. 

Revision of a hip joint will go to a different range of codes. According to Coding Clinic, “Any time the joint is replaced or revised after the initial replacement would be considered a revision” (AHA Coding Clinic for ICD-9-CM, second quarter 1996, page 13). The codes for revision of hip components include the following:

• 00.70, Revision of hip replacement, both acetabular and femoral components;

• 00.71, Revision of hip replacement, acetabular component;

• 00.72, Revision of hip replacement, femoral component;

• 00.73, Revision of hip replacement, acetabular liner and/or femoral head only; and

• 81.53, Revision of hip replacement, not otherwise specified.

Code 81.53 is assigned only if a revision of hip replacement is performed but is not specified as to component(s) replaced.

Coding directives also state to assign an additional code for any type of bearing surface if known, which includes the following:

• 00.74, Hip bearing surface, metal-on-polyethylene;

• 00.75, Hip bearing surface, metal-on-metal;

• 00.76, Hip bearing surface, ceramic-on-ceramic; and

• 00.77, Hip bearing surface, ceramic-on-polyethylene.

Total knee replacement is classified to code 81.54 and involves replacing the articular surfaces of the femoral condyles, tibial plateau, and patella. Code 81.54 also includes bicompartmental knee replacement, partial knee replacement, tricompartmental knee replacement, and unicompartmental (hemijoint) knee replacement.

The codes for revision of knee components include the following:

• 00.80, Revision of knee replacement, total (all components);

• 00.81, Revision of knee replacement, tibial component;

• 00.82, Revision of knee replacement, femoral component;

• 00.83, Revision of knee replacement, patellar component;

• 00.84, Revision of total knee replacement, tibial insert (liner); and

• 81.55, Revision of knee replacement, not otherwise specified.

Code 81.55 is assigned only if a revision of a knee replacement is performed but is not specified as to the component(s) replaced. There is an instructional note under subcategory 00.8 stating, “Report up to two components using 00.81-00.83 to describe revision of knee replacements. If all three components are revised, report 00.80.” In other words, if the tibial and femoral components are revised, assign both code 00.81 and code 00.82.

Code assignment for other joint replacement surgeries include the following:

• 81.56, Total ankle replacement;

• 81.57, Replacement of joint of foot and toe;

• 81.59, Revision of joint replacement of lower extremity, not elsewhere classified;

• 81.80, Total shoulder replacement;

• 81.81, Partial shoulder replacement;

• 81.88, Reverse total should replacement (new code effective October 1);

• 81.84, Total elbow replacement;

• 81.73, Total or partial wrist replacement; and

• 81.97, Revision of shoulder, elbow, or wrist replacement.

Physicians often use the terms “arthroplasty” and “replacement” interchangeably. Arthroplasty is defined as a joint repair. There are different ICD-9-CM codes for arthroplasty if only a joint repair is performed. To distinguish whether an arthroplasty is truly a joint replacement, look for a prosthetic implant. Review the operative report thoroughly for appropriate code assignment.

Common complications that may occur after a joint-replacement surgery include venous thrombosis (category 453), pulmonary embolism (415.11), incision site infection (998.59), intraoperative fracture (998.89), dislocation of prosthesis (996.42), loosening of prosthesis (996.41), breakage of prosthesis (996.43), periprosthetic fracture around prosthetic joint (996.44), change in leg length, joint stiffness, and/or daily wear and tear.

Coding and sequencing for joint replacement are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding.

— This information was prepared by Audrey Howard, RHIA, of 3M Consulting Services. 3M Consulting Services is a business of 3M Health Information Systems, a supplier of coding and classification systems to more than 5,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information. More information about 3M Health Information Systems is available at www.3mhis.com or by calling 800-367-2447.