september 2016

Coding for Joint Arthroplasty Procedures

Let’s take a look at some of the key points of documentation that would assist you in reporting joint arthroplasty procedures. One of the first things I like to confirm is whether the procedure is a hemi-arthroplasty (a portion of the joint is replaced) or is this a total joint arthroplasty where the whole joint is replaced. Next, determine if this is an initial insertion, removal of existing prosthesis or a replacement procedure (which would be reported as a revision arthroplasty) because all of these factors will have an impact on the correct code selection. I would expect this documentation to be found in the PROCEDURES PERFORMED section of the op note.

From there you would go into the narrative of the op note and if this was a hemiarthroplasty of the shoulder the physician would remove the head of the humerus, insert the prosthesis and impact the head of the humerus back into the glenoid. If a total joint arthroplasty then the physician would also insert the glenoid component securing it into place with screws and then impacting the humerus into place.

There are a few variations to some of these procedures based on the type of prosthesis being used. For example, with a shoulder arthroplasty there is what’s called a reverse arthroplasty which only relates to the design of the prosthesis itself and does not change the coding.

Report the removal of prosthesis code when an implant is taken out and that is the only procedure performed. When the prosthesis is removed and new prosthesis is inserted during the same surgical session you would only report the “revision” code and the removal is included in the revision arthroplasty.

Any time a joint prosthesis is replaced you would report a revision code, but again there are variations in coding depending on what is being replaced. Many of the code sets include “or” or “and” in the code description that relates to the components replaced. For example, in the shoulder there is a code for humeral “or” glenoid component or humeral “and” glenoid component. Additionally with the knee and hip revision codes you would add modifier -52 reduced service when the polyethylene liner is the only component replaced.


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