Image by Stephen Woods.
Include this term in Box 19 to indicate the type of implant.
Question: One of our surgeons says we should use a total hip code for Birmingham resurfacing even if he doesn’t complete a total hip procedure; another physician says to use an unlisted code . What’s the correct answer?
Washington Subscriber
Answer: Both of your physicians could be right depending on the situation, so check with the payer before submitting your claim following one of these options:
- Report 27125 (Hemiarthroplasty, hip, partial [e.g., femoral stem prosthesis, bipolar arthroplasty]) or 27130 (Arthroplasty, acetabular and proximal femoral prosthetic replacement [total hip arthroplasty], with or without autograft or allograft) based on whether the surgeon places an acetabular component.
- Report 27299 (Unlisted procedure, pelvis or hip joint) and compare to _______ for reimbursement purposes.
- Some private payers such as Blue Cross/Blue Shield request S2118 (Metal-on-metal total hip resurfacing, including acetabular and femoral components) for hip resurfacing instead of the CPT codes.
Once you select a code, include “Birmingham” in Box 19 to notify the payer of the type of implant used.
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