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ASC Coding: Hip and Knee Procedures

By Paul Cadorette, CPC, COC, CPC-P, COSC, CASCC, Director of Education, nimble solutions
Register for the Hip and Knee Coding Course and all other courses in the Anatomy of Coding Educational Series here.

From the OvertureTi Knee Resurfacing System to the Nanofracture procedure, ASC coding for hip and knee procedures can be complex and nuanced. Our upcoming ASC coding course on hip and knee procedures will cover these topics, plus the latest technologies and techniques ASC coders need to know. 

Read on to get a preview of some of the topics covered in this course, including specific CPT codes for total hip arthroplasty.   

Conversion of Previous Hip Surgery to Total Hip Arthroplasty 

When reporting CPT code 27132, which represents the conversion of previous hip surgery to total hip arthroplasty, it is important to understand the guidance provided by the AMA. 

 According to a CPT Assistant article from December 2008, “27132 applies to any previous hip surgery (except total hip arthroplasty) in the patient’s surgical history where a skin incision was made.” 

I receive many questions regarding the phrase “where a skin incision was made” such as, what if the previous surgery was arthroscopic? 

Here’s an example: if a child treated with a harness for hip dysplasia later undergoes a total hip arthroplasty, it would not be appropriate to report 27132 in that scenario. 

However, if the patient had undergone percutaneous, endoscopic, or open surgery of the hip as a child, then code 27132 would be applicable.  

Thus, percutaneous and endoscopic techniques are considered valid for reporting 27132, even if they do not involve a traditional skin incision. 

Correspondence with the AMA has clarified that the conversion code is necessary whenever a patient has had surgery in the hip area resulting in scarring and an altered surgical field, making subsequent surgery more challenging. 

Prior Authorization Considerations for Arthroscopic Hip Procedures 

A labral hip tear (CPT 29916) can often be accompanied by femoroacetabular impingement (FAI), which includes associated cam and pincer lesions. In this scenario, it is common for the physician to perform three arthroscopic surgical procedures: femoroplasty (29914), acetabuloplasty (29915), and labral repair (29916). 

In many instances, prior authorization is required for arthroscopic hip procedures. Unfortunately, if prior authorization is only obtained for the arthroscopic labral repair code 29916, the claim can be denied.  

When the patient undergoes surgery, all three procedures (29914, 29915, 29916) are performed, coded, and the claim is submitted. However, if 29916 was the only code authorized and if the carrier is following CCI edits (and 29916 is now bundled into 29915), the claim will unfortunately be denied.   

It would be beneficial to the ASC to authorize all three CPT codes in this scenario to ensure your best possible outcome for receiving reimbursement. 

ASC Coding Course for Hip and Knee Procedures 

Stay ahead in the field of orthopedic coding by joining our ASC coding course on Hip and Knee Procedures.  

We will cover these critical topics and more, ensuring you are equipped with the knowledge needed to code accurately and efficiently.  

Don’t miss out on the opportunity to learn about the latest technologies and coding practices in hip and knee procedures. 

  • Date: July 16, 2024 
  • Time: 1:00 – 2:00pm Central 
  • Focus: Latest technologies, coding updates, and best practices for hip and knee procedures; earn CEUs from AAPC 

Ensure your spot today by registering for this course; you’ll also gain the opportunity to earn CEUs from AAPC.  

Click here to learn more about the courses available in the 2024 Anatomy of Coding Educational Series.