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Coding insights: Total Joint Arthroplasty

Paul Cadorette, CPC, COC, CPC-P, COSC, CASCC, Director, Training and Education, Coding
Watch the Anatomy of Coding Total Joint Arthroplasty coding course on demand. Register here.

Accurate coding is the cornerstone of successful revenue management for ambulatory surgery Centers (ASCs), especially when it comes to Total Joint Arthroplasty procedures. The correct utilization of CPT codes, ICD-10 codes, and modifiers is vital for precise reporting and timely reimbursement.

What is Total Joint Arthroplasty? 

Total Joint Arthroplasty (TJA), also known as joint replacement surgery, involves the replacement of damaged or diseased joints with artificial ones.

When it comes to TJA replacement procedures, the codes are fairly consistent in that each anatomical section includes codes for insertion, removal, and revision services.

In this blog post, I’ll discuss some key coding considerations for TJA procedures that will be covered in greater depth during the webinar.

Understanding Total Joint Arthroplasty procedures  

TJA procedures include hip replacements, knee replacements, shoulder replacements, and ankle replacements. The type of procedure and the reason for the procedure will determine what codes should be used.  

For example, patients with previous hip surgery in their surgical history may require a conversion to total hip arthroplasty. Reporting the appropriate CPT code (27132) is crucial in such cases.

However, it’s important to note that this does not include patients who have already undergone a total hip arthroplasty or arthroscopic procedures.

The Role of Modifier -52

There are some variations in the code sets such as conversion hip, fractures with prosthetic replacement, reduced services (modifier -52), and use of unlisted CPT codes based on the actual services being performed.

Modifier -52 is typically used when replacing the poly component of a prosthetic device. This modifier may also be appended when converting a hemiarthroplasty to total joint arthroplasty in the knee.

Unlisted CPT Codes for Unique Services

Certain services performed during TJA procedures may not have specific CPT codes available. In such cases, reporting an unlisted CPT code becomes necessary. Two examples are patellofemoral arthroplasty and focal resurfacing implants. There are no specific CPT codes available to describe a patellofemoral arthroplasty procedure. This is because such procedures involve unique anatomical considerations. Additionally, focal resurfacing implants, which aim to replace damaged cartilage without removing bone or using prosthetic components, also do not have dedicated CPT codes.

Unlisted codes highlight why it’s important to have consistent documentation for each procedure. The patient’s medical record should include the reason for the TJA procedure, plus any preoperative evaluations and postoperative care, including physical therapy.   

This blog post outlines some of the topics covered in the 2023 Total Joint Arthroplasty coding course, available on demand with corresponding AAPC continuing education units included.