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August 30, 2010 Coding for Joint Replacement For The Record Vol. 22 No. 16 P. 28

Joint replacement surgery involves removing a diseased joint and replacing it with an fabricated prosthetic joint with the score of relieving pain and increasing mobility and function. The hip and knee joints most typically require replacement.

Total hip replacement is divide to code 81.51, and partial hip instead of goes to code 81.52. A complete hip replacement requires replacing the femoral head and also the acetabular articular surface. A partial i know good replacement, additionally documented together hemiarthroplasty, requires replacing only the femoral head. A bipolar hemiarthroplasty is a specific kind of hemiarthroplasty in which a femoral prosthesis is offered with an articulating acetabular component, yet the acetabular cartilage is not replaced.

Revision that a hip joint will go come a different variety of codes. Follow to Coding Clinic, “Any time the joint is replaced or revised after ~ the initial replacement would certainly be considered a revision” (AHA Coding Clinic because that ICD-9-CM, 2nd quarter 1996, web page 13). The codes for revision that hip components include the following:

• 00.70, review of i know good replacement, both acetabular and femoral components;

• 00.71, revision of i know well replacement, acetabular component;

• 00.72, review of i know well replacement, femoral component;

• 00.73, review of i know good replacement, acetabular liner and/or femoral head only; and

• 81.53, revision of i know well replacement, not otherwise specified.

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Code 81.53 is assigned just if a revision of hip instead of is performed yet is no specified regarding component(s) replaced.

Coding directives likewise state to assign secondary code because that any form of bearing surface if known, which consists of the following:

• 00.74, i know well bearing surface, metal-on-polyethylene;

• 00.75, i know well bearing surface, metal-on-metal;

• 00.76, i know well bearing surface, ceramic-on-ceramic; and

• 00.77, hip bearing surface, ceramic-on-polyethylene.

Total knee replacement is share to password 81.54 and also involves replacing the articular surface of the femoral condyles, tibial plateau, and patella. Password 81.54 additionally includes bicompartmental knee replacement, partial knee replacement, tricompartmental knee replacement, and also unicompartmental (hemijoint) knee replacement.

The codes because that revision that knee contents include the following:

• 00.80, revision of knee replacement, complete (all components);

• 00.81, review of knee replacement, tibial component;

• 00.82, revision of knee replacement, femoral component;

• 00.83, review of knee replacement, patellar component;

• 00.84, revision of total knee replacement, tibial insert (liner); and

• 81.55, review of knee replacement, not otherwise specified.

Code 81.55 is assigned just if a revision of a knee instead of is performed however is no specified regarding the component(s) replaced. There is one instructional keep in mind under subcategory 00.8 stating, “Report as much as two contents using 00.81-00.83 to explain revision that knee replacements. If all three components are revised, report 00.80.” In various other words, if the tibial and femoral materials are revised, entrust both password 00.81 and code 00.82.

Code assignment for other joint instead of surgeries incorporate the following:

• 81.56, full ankle replacement;

• 81.57, replacement of joint of foot and toe;

• 81.59, revision of share replacement of reduced extremity, not in other places classified;

• 81.80, complete shoulder replacement;

• 81.81, Partial shoulder replacement;

• 81.88, Reverse total should instead of (new code reliable October 1);

• 81.84, complete elbow replacement;

• 81.73, total or partial wrist replacement; and

• 81.97, review of shoulder, elbow, or wrist replacement.

Physicians regularly use the state “arthroplasty” and also “replacement” interchangeably. Arthroplasty is identified as a share repair. Over there are different ICD-9-CM codes because that arthroplasty if only a share repair is performed. To distinguish whether an arthroplasty is truly a share replacement, look because that a prosthetic implant. Review the operative report completely for appropriate code assignment.

Common complications that may occur after a joint-replacement surgery include venous thrombosis (category 453), pulmonary embolism (415.11), incision site infection (998.59), intraoperative fracture (998.89), dislocation of prosthesis (996.42), loosening of prosthesis (996.41), not correct of prosthesis (996.43), periprosthetic fracture roughly prosthetic share (996.44), readjust in leg length, joint stiffness, and/or everyday wear and tear.

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Coding and sequencing because that joint replacement are dependent on the physician documentation in the medical record and also application the the main Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic because that ICD-9-CM and also American clinical Association CPT Assistant recommendations to ensure complete and accurate coding. — This details was prepared by Audrey Howard, RHIA, that 3M Consulting Services. 3M Consulting solutions is a company of 3M wellness Information Systems, a providers of coding and also classification solution to an ext than 5,000 health care providers. The agency and that is representatives perform not assume any kind of responsibility for reimbursement decision or insurance claims denials made by suppliers or payers together the an outcome of the misuse that this coding information. Much more information around 3M wellness Information solution is accessible at www.3mhis.com or by call 800-367-2447.