At $276 extra a pop, understanding -requiring anesthesia- is worth the effort To choose the proper code from 27250-27254, you need to look for certain elements -- anesthesia, trauma, and fracture, to name a few. But some are easier to spot than others. Here's how to avoid the common pitfalls traumatic hip dislocation coding presents. 27250/27252: Watch Anesthesia Requirements Your first two coding options are 27250 (Closed treatment of hip dislocation, traumatic; without anesthesia) and 27252 (- requiring anesthesia). Two requirements for these codes are fairly straightforward. Both codes are for (1) closed treatment and (2) traumatic dislocations. Gray area: Coders often encounter trouble deciding whether the treatment qualifies as "requiring anesthesia" because of the different types, including local and general anesthesia and conscious sedation, warns Denise Paige, CPC, billing manager at Torrance Orthopaedic & Sports Medicine Group in Torrance, Calif. Different sources have different opinions on what anesthesia refers to in code descriptors. An August 2005 AAOS Bulletin article describing 26340 (Manipulation, finger joint, under anesthesia, each joint) states that "the terms -under anesthesia- or -with anesthesia- are now understood to reflect the appropriate anesthesia for a given patient and/or given situation," rather than being limited to general anesthesia. But CPT Assistant (April 2005), referring to 23700 (Manipulation under anesthesia, shoulder joint, including application of fixation apparatus [dislocation excluded]), states that the "code descriptors, which include the phrase -requiring anesthesia- or -under anesthesia,- indicate that the work involved in that specific procedure requires the use of general anesthesia." Safe bet: Report 27252 only if the surgeon uses general anesthesia, unless your payer tells you in writing that this code is appropriate for other forms of anesthesia, as well. Code 27252 has 7.25 more transitioned total relative value units than 27250 in the Medicare Physician Fee Schedule. Multiply 7.25 by the 38.087 conversion factor, and that translates to $276 more dollars before adjusting for geography. You don't want to miss out on that when you deserve it -- and you don't want to have to pay it back for improper coding. 27253/27254: Catch Fracture, Ex Fix Blunders Your next two options are open treatment codes for traumatic dislocations: 27253 (Open treatment of hip dislocation, traumatic, without internal fixation) and 27254 (Open treatment of hip dislocation, with acetabular wall and femoral head fracture, with or without internal or external fixation). Again you should be able to narrow your options to these two codes easily by identifying two elements: open treatment and traumatic dislocation. But you need to be on your toes to distinguish dislocation alone (27253) from dislocation with fracture (27254). "Fractures and dislocations are under the same section in the CPT book and some physicians call these -fracture/dislocation- in their dictation," says Paige. You may need to seek clarification from the physician for proper coding: "Is it a fracture, is it a dislocation, or both?" she says. Don't miss: Both codes are appropriate for treatment without internal fixation, but 27254 states "with or without internal or external fixation." Translation: You should not report an external fixation code with 27254, says Heather Corcoran, coding manager for CGH Billing in Louisville, Ky. Although CPT changed many descriptors to allow you to bill external fixation (20690, 20692) separately with several other codes, CPT includes fixation in 27254. If you try to report the two together, your system should kick out the fixation code, Corcoran says. Correct Coding Initiative (CCI) edits bundle the external fixation codes into 27254. 835.XX: Follow These 5th Digit Clues The ICD-9 manual groups your hip dislocation coding options into one handy group: - 835.0X -- Dislocation of hip; closed dislocation - 835.1X -- - open dislocation. You will see closed dislocations more often than open, but your surgeon should document which it is, Paige says. If not, be sure to verify before coding. Your fifth digit options are as follows: - 0 -- - dislocation of hip, unspecified - 1 -- - posterior dislocation - 2 -- - obturator dislocation - 3 -- - other anterior dislocation. Your surgeon should document whether the dislocation is posterior, obturator, or another anterior type. If you don't have that information, ask for clarification, suggests Susan Vogelberger, CPC, CPC-H, CPC-I, CMBS, CCP-P, president of Ohio-based Healthcare Consulting & Coding Education. Tip: Fifth digit "3" states "other anterior dislocation" because obturator dislocation is classified as an anterior dislocation, although it has distinct clinical indicators. The other anterior dislocations you may see (and use fifth digit "3" for) are iliac and pubic. But be prepared. The vast majority of dislocations are posterior, which may occur, for example, when the patient's knee hits the dashboard during a head-on collision. Watch out: You have other ICD-9 options for nontraumatic hip dislocations. See "2 Tips Round Out Your Hip Dislocation Know-How" below for more information. Modifier 57: Succeed With E/M + Treatment You-ll see the majority of hip dislocations in the hospital or emergency department (ED), rather than in the office, says Paige. If the ED doctor calls your surgeon to evaluate and treat the patient, you may report both an E/M and the treatment as long as the documentation reflects a separately identifiable E/M service. Don't forget: You should append modifier 57 (Decision for surgery) to the E/M code, says Paige.
FAQs
What is the most * common complication of hip dislocations? ›
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.
What is the most common injury associated with a traumatic posterior hip dislocation? ›Nerve injury.
As the femur is pushed out of the socket, particularly in posterior dislocations, it can crush and stretch nerves in the hip. The sciatic nerve, which extends from the lower back down the back of the legs, is the nerve most commonly affected.
- Acute pain.
- Muscle spasms.
- Swelling or discoloration at your hip joint.
- Leg is rotated inward or outward.
- Inability to move your leg.
- Inability to bear weight on your leg.
- Loss of feeling in your hip or foot.
- Hip is visibly out of place.
When the ball is not fully in the socket it is called hip subluxation. Hip subluxation can cause limited range of motion of the hip and change growth of the femur and hip bone. Over time, a subluxed hip can become dislocated when the ball of the hip is not in the socket at all and can cause pain.
What are the long term complications of dislocations? ›Long-term complications of dislocations include the following: Instability: Various dislocations can lead to joint instability. Instability can be disabling and increases the risk of osteoarthritis. Stiffness and impaired range of motion: Stiffness is more likely if a joint needs prolonged immobilization.
What nerve is injured in traumatic dislocation of the hip? ›The sciatic nerve is the most commonly injured nerve in traumatic hip dislocations. The sciatic nerve includes the nerve roots L4 to S3 and before exiting the pelvis divides into a tibial branch and peroneal branch, which usually travel in a common sheath past the hip.
What are the complications of traumatic dislocation? ›- Muscle strains.
- Ligament and tendon sprains.
- Nerve damage.
- Damaged blood vessels.
- Bone fractures (broken bones).
- Keep your knees and toes pointed forward when you sit in a chair, walk, or stand.
- Do not sit with your legs crossed.
- Do not bend at the waist more than 90º. Be careful when leaning or when moving in bed to keep your legs as straight ahead as possible.
Stretching and range-of-motion exercises are important early in the recovery process, advancing to walking on crutches when the patient's pain fully resolves. Strengthening exercises of the muscles around the hip are important during the rehabilitation to take stress off the injured joint.
What does a hip subluxation feel like? ›Sometimes, you can feel like your hip has almost popped out of its usual spot, called the hip socket. A partially dislocated hip's symptoms include pain, stiffness, and a limited range of motion. People might also notice their leg feels weird or looks different.
What is the Bigelow maneuver? ›
The Bigelow maneuver is the final method of closed reduction. As in the Allis maneuver, an assistant applies pressure to the anterior spines of the patient's pelvis for stability. One hand is used to apply traction on the affected leg by pulling on the ankle, while the other forearm is placed under the knee.
What is the most painful dislocation? ›Forwards (or anterior) dislocations of the shoulder are extremely painful and it is impossible to move the arm. There may be a deforming bulge in the front of your shoulder area, below the natural shoulder joint. This will be the ball of the upper arm bone, called the humeral head, that has slipped out.
What is snapping hip syndrome? ›Snapping hip syndrome is a condition in which you may sense something catching or hear a popping sound or click in your hip when your hip joint moves. If you put your hand over the hip area, you might feel or even see the snap happen when walking, running, bending or getting up from a sitting position.
Can a hip pop out and back in? ›Of course, a patient who can actively pop the hip in and out of the socket has a clear case of hip instability. Once the diagnosis has been made, forming a plan of care is next. Treatment depends on the extent of injury or damage as well as the degree of instability.
Can you walk on a subluxed hip? ›Partial hip dislocation (hip subluxation)
A partial hip dislocation can occur when the ball joint is not pushed all the way out of the socket. Partially dislocated hip symptoms are similar to a total hip dislocation, but the pain may not be as severe. In mild cases, you might be able to walk and bear weight.
After hip dislocation, complications such as muscle paralysis and degeneration of the femoral head are likely to develop. Pain of the pubic symphysis (termed osteitis pubis) is common in runners, soccer players, football players, and wrestlers.
What is the most common complication of hip surgery? ›One of the most common serious medical complications related to joint replacement surgery is blood clots. Deep vein thrombosis (DVT) refers to a blood clot in the leg and is called a deep vein thrombosis. A sudden increase in leg swelling along with calf tenderness may be the first sign of a blood clot in the leg.
What is the most common and significant complication following hip fracture? ›Serious complications can result from a hip fracture. A patient may have to remain in traction for a specified period of time after surgery. Blood clots can occur in the veins, usually in the legs. If a clot breaks off, it can travel to a blood vessel in the lung.
What are the complications of hip replacement dislocation? ›Dislocation is uncommon. The risk for dislocation is greatest in the first few months after surgery while the tissues are healing. If the ball does come out of the socket, your doctor can perform a procedure (called a closed reduction) that can usually put it back into place without the need for more surgery.