If you miss the difference between 27250 and 27252, you could miss out on almost $600. Because coding hip dislocations can be disorienting, you are liable to lose out on the reimbursem*nts that your provider deserves. To ethically boost your bottom line, pay attention to these three elements of hip dislocation codes. First, before learning the tricks to recognizing how these three elements can help you, familiarize yourself with the following codes that deal with hip dislocation. By learning all you can about the codes starting at 27250 and ending at 27254, you will be able to avoid challenging audits and get the most out of your reporting. Let’s break these codes down: Elements: The major overlapping elements found in these descriptions are: To code properly, think about this as a choose-your-own-adventure; meaning that as you determine which elements pertain to a specific procedure, you will be led to more specific elements that ultimately describe the final code you will want to report. 1. Start by Determining Type of Treatment This is where you begin to break down your codes into two groups. As you can see, each code definition begins by identifying if the procedure is an open procedure or a closed procedure. Knowing the definition of each treatment is half the battle. Literally, if you can determine which treatment was performed, you will be able to use codes 27250 or 27252 and for open treatment or codes 27253 or 27254. So what is a closed treatment? A closed treatment refers to the area of a fracture on a dislocated bone. If the fracture site is not surgically opened, then this is what physicians call a closed treatment. Alternatively, an open treatment refers to a procedure when the bone is either surgically opened or the fractured bone is opened remote from the fracture site so an intramedullary nail can be inserted across the fracture site. Once you know which treatment was performed, you can move on. 2. If This Was a Closed Treatment, Determine If Anesthesia Was Required Let’s say you have determined a closed treatment was performed – now you must decide whether to use code 27250 or 27252. In order to do this, you must pay close attention to the next element: anesthesia. When deciding which code to use, notice the language of codes 27250 and 27252. Both reference anesthesia. Code 27250 plainly states that no anesthesia was used during the procedure. The confusion, however, comes when examining the language for the next code. Notice that code 27252 states that it requires anesthesia. So although you may not encounter this situation clinically, you might be wondering if anesthesia was used, but not necessarily required, should you use this code? Though different practices approach this question differently, what you as the coder should know is what kind of anesthesia was used (hypothetically). You can assume for these types of procedures that either a general anesthesia or conscious sedation was used. The general rule of thumb is to report 27252 only in circ*mstances when the orthopedic surgeon uses general anesthesia instead of conscious sedation. However, this code can be used to include conscious sedation if your payer otherwise expresses written permission that the code is appropriate for use during the procedure. Let’s look at the numbers. Code 27250 is listed at $186.26 payable under the National Physician Rate. Compare that to the 27252 code is listed at $781.66. The numbers speak for themselves. A careful eye and a tenacious coder can get the most out of this procedure by paying attention to the code definitions. 3. If This Was an Open Treatment, Determine If Fixations Were Used So what do you do if this was an open procedure? You now know that you will be using either code 27253 or code 27254. Note that the dislocation can require varying degrees of care. Take a careful look at the extent of the dislocation before choosing a code. Here is an easy tip that all coders should keep in mind so you can easily determine if you should use code 27253 or code 27254. Tip: Carefully look at the language of the code definitions. Although similar, code 27254 requires an internal or external fixation. An internal or external fixation is a device such as plates and screws that stabilize a fracture in an open surgical procedure. These fixations are your dead giveaways to use the latter code. “For acetabular wall fractures, we virtually never use wires and absolutely never use nails,” says Bill Mallon, MD, former medical director, Triangle Orthopedic Associates, Durham, N.C. Code 27253 does not make use any of these tools so if a provider does or does not utilize fixations, you can determine which code to use easily. One more helpful hint is to keep in mind that you can only report code 27254 with an associated acetabular wall or femoral head fracture. If neither of these indicators are present, look for another code, says Heidi Stout, BA, CPC, COSC, PCS, CCS-P, with Coder on Call, Inc., in Milltown, New Jersey. The Step-By-Step Breakdown Remember: Determine what kind of treatment took place first. After you know this, further specify closed treatments by reviewing the use of anesthesia and further specify open treatments by reviewing the use of fixations. By doing this, your code reporting can earn a provider the maximum it deserves.
FAQs
What are 3 features of a hip dislocation? ›
Other common features include: leg length discrepancy: hip immobility with reduced hip range of motion. Signs of possible vascular or sciatic nerve injury: Local hematoma. Painful buttock, posterior thigh, and leg. Altered sensation in posterior leg and foot.
What is the management for a dislocated hip? ›Hip reduction: To correct your dislocated hip, your healthcare provider will physically move your joint back into place. This is called a reduction. When there aren't any secondary injuries, the correction can be done externally (“closed reduction”).
What is the line for a dislocated hip? ›Shenton's line irregularity occurs in hip dislocation or in the neck of femur fractures without dislocation. Assess if the femoral head fracture is present whether it is above or below fovea capitis. The femoral head appears smaller than the contralateral side.
What are the hip precautions to prevent dislocation? ›Hip precautions encourage patients to avoid bending at the hip past 90°, twisting their leg in or out, and crossing their legs. Patients are also encouraged to sit with their hips higher than their knees, sit in a chair with armrests, and sleep on their back with a pillow between their legs.
What are the three main components of hip? ›The hip joint is the junction where the hip joins the leg to the trunk of the body. It is comprised of two bones: the thighbone or femur, and the pelvis, which is made up of three bones called ilium, ischium and pubis. The ball of the hip joint is made by the femoral head while the socket is formed by the acetabulum.
How do you strengthen a dislocated hip? ›You can also strengthen your hip muscles by performing standing knee raises four times daily. First, stand behind a sturdy chair, and grab its back with both of your hands. Next, gradually raise your injured leg while smoothly bending the knee. However, don't lift the knee higher than waist level.
What is the most common complication of hip dislocation? ›Hip dislocation is very painful and can cause tears or strains in adjacent blood vessels, nerves, muscles, ligaments and other soft tissues. The most serious complications associated with hip dislocations are avascular necrosis (bone death), and sciatic nerve damage.
Is walking good for a dislocated hip? ›The knowledgeable team at Nevada Orthopedic recommends immobilizing the joint as much as possible while it recovers to prevent repeat injuries or new injuries due to the weakened joint. After a few weeks of rest, we may recommend physical therapy or temporarily walking with crutches or other walking aids.
How do you rule out a hip dislocation? ›- X-rays. Hip dislocations usually are obvious on standard AP (anteroposterior) images of the pelvis. ...
- Computed tomography. CT (Computed tomography) is recommended after a successful, closed hip reduction to evaluate for occult fractures. ...
- MRI. ...
- Other Testing.
- Increasing pain in the hips during or after exercise.
- Pain in the hips and lower back while standing.
- Pain in the lower back while lying down.
- Uneven gait.
How to improve hip instability? ›
- 1.) Clamshells.
- 2.) Bridging.
- 3.) Hip Abduction.
- 4.) Side Plank.
- 5.) Lateral Mini-Band Walking.
Gently abduct, externally rotate, and extend the hip while distracting the femoral head anteriorly. Large amounts of rotational force should be avoided because they have been associated with iatrogenic femoral neck fractures.
What are the main hip precautions? ›- Do not bend the hip more than 90 degrees.
- Do not cross legs or feet.
- Do not roll or lie on the unoperated side for the first 6 weeks.
- Do not twist the upper body when standing.
- Sleep on the back for the first 6 weeks.
- The patient may benefit from a shower chair or elevated seat for home use.
- Don't put off medical care. Get medical help as soon as you can.
- Don't move the joint. Until you get help, use a splint to keep the affected joint from moving. ...
- Put ice on the injured joint. This can help reduce swelling.
Pain is the most common symptom associated with any dislocation, followed by an inability to use the joint. Some joints will also have an obvious deformity if they are dislocated. Other symptoms include: Swelling.
What are the characteristics of dislocation? ›A dislocation can be characterised by the distance and direction of movement it causes to atoms which is defined by the Burgers vector. Plastic deformation of a material occurs by the creation and movement of many dislocations. The number and arrangement of dislocations influences many of the properties of materials.
What are the special features of the hip joint? ›The hip acts as a multi-axial, ball-and-socket joint upon which the upper body is balanced during stance and gait. The balance and stability provided by the hip joint allow motion while supporting forces encountered during daily activities.
What does a dislocated hip look like? ›After a dislocation, the leg on the affected hip will look shortened and turned. Your knee and foot will either point outward (anterior dislocation) or inward (posterior dislocation). Traumatic posterior hip dislocations are the most common type of hip dislocation, usually the result of a motor vehicle accident.