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Special AHIMA Edition September 2013

Coding for Hip Replacement Surgery
For The Record
Vol. 25 No. 13 P. 26

Hip replacement surgery involves removing the diseased hip joint and replacing it with artificial prosthetic components. Conditions that may damage the hip, necessitating a hip replacement, include osteoarthritis, rheumatoid arthritis, posttraumatic arthritis, hip fracture, avascular necrosis/osteonecrosis, a bone tumor, and childhood hip disease. The goal of replacement surgery is to relieve pain and restore mobility and function of the damaged hip joint.

In a total hip replacement (ICD-9-CM code 81.51), the femoral head is removed and replaced with a metal stem, which is placed into the center of the femur, and a metal or ceramic ball. The “socket” part of the acetabulum is removed and replaced with a metal socket. A plastic, ceramic, or metal spacer (also called a liner or insert) is placed between the new femoral head and socket to allow for a smooth surface.

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

In a partial hip replacement (81.52), also called a hemiarthroplasty, only the femoral head is replaced and the acetabulum is left in place. A partial hip replacement is done mainly to repair fractured hips. The prosthetic device typically used in partial hip replacements incorporates a one-piece solid metal ball and stem that replaces the femoral head and upper femur, unlike the two-piece stem and ball design used in total hip replacements. The Austin Moore and Thompson prostheses are common examples of the one-piece design used in partial hip replacements. Other prosthetic devices are considered modular and allow for different combinations of stem, neck length, and head size.

Although hip replacements are effective in relieving pain and restoring mobility and function to the hip joint, they do not last forever. The typical life span of a hip prosthesis is 10 to 15 years. Revision of the hip joint may be necessary to repair the prosthesis that has been damaged over time because of infection or normal wear and tear on the prosthesis. Revision of a hip joint will go to a different range of codes. “Any time the joint is replaced or revised after the initial replacement would be considered a revision” (AHA Coding Clinic for ICD-9-CM, 1996, second quarter, page 13). The codes for revision of hip components include the following:

• 00.70, Revision of hip replacement, both acetabular and femoral components (includes total hip revision);

• 00.71, Revision of hip replacement, acetabular component (includes partial hip revision of acetabular component only and that with exchange of acetabular cup and liner or exchange of femoral head);

• 00.72, Revision of hip replacement, femoral component (includes partial hip revision of femoral component only and that with exchange of acetabular liner or exchange of femoral stem and head);

• 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.

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 plus an additional code to describe the type and site of the fracture), 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 daily wear and tear.

Coding and sequencing for hip replacement surgery depend 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, senior consultant with 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.


ICD-10-PCS Coding for Hip Replacement
The ICD-10-PCS root operation for total or partial hip replacements is replacement, which is defined as “putting in or on biological or synthetic material that physically takes the place and/or function of all or a portion of a body part.” The body part either will be right hip joint or left hip joint, and the approach will be open. If the procedure is performed on the right and left hip joints, then two separate procedures are assigned to show the bilateral procedure. The following are the choices for the device (character 6):

• synthetic substitute, metal;

• synthetic substitute, metal on polyethylene;

• synthetic substitute, ceramic;

• synthetic substitute, ceramic on polyethylene; and

• synthetic substitute.

For the qualifier (character 7), the choices include cemented, uncemented, or no qualifier. For example, a left total hip arthroplasty using a cemented stem and a metal-on-plastic articulating surface is classified to code 0SRB029.

Replacement includes taking out the body part (eg, hip joint). According to the ICD-10-PCS Official Guidelines for Coding and Reporting, “Components of a procedure specified in the root operation definition and explanation are not coded separately. Procedural steps necessary to reach the operative site and close the operative site, including anastomosis of a tubular body part, are also not coded separately. Example: Resection of a joint as part of a joint replacement procedure is included in the root operation definition of Replacement and is not coded separately” (2013, page 5).

For the revision of hip replacements, the appropriate code assignment will depend on the intent of the procedure. If the objective is to adjust the device, then the appropriate root operation is revision, which is defined as “correcting, to the extent possible, a malfunctioning or displaced device.” If the objective is to remove and replace the device, then two root operations are used in ICD-10-PCS, replacement and removal. In other words, one code is assigned for the removal of the device used in the previous replacement procedure, and one code is assigned for the placement of a new device.

If the objective of the procedure is to reinforce or augment a previously replaced body part, the root operation of supplement is used, and this is defined as “putting in or on biologic or synthetic material that physically reinforces and/or augments the function of a portion of a body part.” Putting in a new acetabular liner would be an example of this type of procedure.

— AH