Q&A: CPT coding for a hip hemiarthroplasty

Q: A physician performs a hemiarthroplasty for a hip fracture. Would this procedure be reported with CPT code 27125 (hemiarthroplasty, hip, partial [e.g., femoral stem prosthesis, bipolar arthroplasty])?

A: Per the CPT Manual, CPT code 27125 is reported for degenerative changes, not fracture conditions. CPT code 27236 (open treatment of femoral fracture, proximal end, neck, internal fixation or prosthetic replacement) would be used to report a hemiarthroplasty for a hip fracture. At my practice, coders get this wrong 98% of the time.

When coding from the operative report, use caution when assigning the appropriate hip hemiarthroplasty codes. If the femoral head is replaced by a prosthesis called a bipolar type of femoral head replacement, do not automatically assign code 27125.

The "bipolar" refers to the two materials of which the prosthetic is made and not the type of procedure performed. Code 27236 is assigned for hemiarthroplasty following fracture; code 27125 is assigned for hemiarthroplasty secondary to degenerative arthritis and other similar diseases and conditions.

Editor’s note: Lynn Anderanin, CPC, CPC-I, CPMA, CPPM, COSC, senior director of coding compliance and education for Healthcare Information Services, answered this question during HCPro’s webinar, Reinforce ICD-10-CM and CPT Coding for Major Joint Arthroscopies and Total Joint Replacements.

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