Simplifying the CPT Code for Total Hip Arthroplasty

Are you an orthopedic surgeon who makes a difference for patients’ lives by providing total hip arthroplasty (THA)? Though your work provides relief and improved mobility to the patients, you might find challenges in the THA coding and billing processes. Well, this blog post is here to help. 

In this guide, we have outlined the main CPT codes for THA surgeries and different guidelines to follow when coding the service, and we will show how outsourcing billing services to a third party comes with a lot of benefits. This way, you can concentrate on the task at hand, which is to give the best service to your valued patients.

Understanding  Total Hip Arthroplasty

Total hip arthroplasty, or total hip replacement, is a surgical treatment that involves replacing the hip joint that has been damaged with an artificial one. This procedure is for patients with extreme hip pain and rigidity, which may be due to osteoarthritis or fractures. 

In THA, the surgeon takes out the degenerative elements of the hip joint and implants a metal shell in the socket and an acrylic or metal ball fixed to a stem on the thigh bone. This replicates the actual structure of a joint, thereby providing real relief from pain and enhancement of mobility. 

Thus, after receiving the PT, every patient has the possibility to significantly improve the quality of his or her life, to get stronger and more flexible, as well as to be prepared to carry out daily tasks, often without the help of other people.

Key CPT Codes for Total Hip Arthroplasty (THA) 

Here’s a list of the key CPT codes used in Total Hip Arthroplasty (THA) procedures:

Primary THA

27130: Arthroplasty, acetabular and proximal femoral prosthetic replacement, with or without autograft or allograft. This is the primary code for a standard THA implying the replacement of both the acetabular socket and femoral head.

Revision Procedures

27132: Conversion of hip surgery to total hip arthroplasty. This code applies when there is a previous hip surgery that has to be revised into a primary THA.

27134: Revision of total hip arthroplasty: both components, with or without autograft or allograft. This is a component that is used in a revision surgery to replace both acetabular liner and femoral parts.

27137: Revision of total hip arthroplasty: acetabular component only, with or without autograft or allograft. This code is specifically used in clinical scenarios that only the liner in the acetabular socket is replaced.

27138: Revision of total hip arthroplasty; femoral component only, with or without allograft. This code is applicable in a revision THA whereby the surgeon removes only the femoral component which is referred to as the stem.

Additional Considerations

Removal of Prosthesis (without revision):If the prosthesis is taken out but no revision or replacement is done, then there is a different code series involved (27090 – 27091).

Essential Guidelines for Accurate THA Coding

Accuracy is Paramount

It is important to designate the most accurate CPT code relating to the distinct THA procedure. Avoid the use of ambiguous codes. Make sure that the code incorporates the precise parts that have been replaced and any other procedures that may have been undertaken. E.g Bone grafting.

Stay Updated

CPT codes update their codes from time to time. The providers of health billing services should make sure they and their billing staff understand any new coding changes issued by the AMA. This helps in the timely submission of claims and also prevents denials in the near future, if any.

Consult Reliable Resources

It refers to the consultation of the current CPT codebook available at the AMA’s website and uses coding materials for special cases. There are various sources of information for orthopedic coding, among which is the American Academy of Orthopaedic Surgeons (AAOS).

Consider Additional Procedures

List and categorize any other procedures carried out at the time of THA, including bone grafting, use of different approaches, etc. (e.g., extensile lateral, anterior). These procedures may have their own CPT codes that may be listed in a CPT code reference book.

Outsource Your THA Billing and Coding to a Reliable Medical Billing Company

THA procedures are performed by orthopedic surgeons, and these surgeons are confronted with specific billing issues. Challenges such as timely and precise code assignment for standard and revision THA surgeries associated with challenging billing issues may hinder practice efficiency. This is why outsourcing billing to our expert medical billing and coding services at Medheave presents a viable solution. This way, you get the right CPT codes for total hip arthroplasty and maximize your reimbursement. Additionally, the company enables surgeons to spend a lot of time with patients while having confidence that billing issues are professionally dealt with. 

Contact Medheave today and streamline the cash flow of your total  Hip Arthroplasty center.

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