Does Medicare cover CPT code 27130?

CMS removed CPT code 27130 (THA) from the IPO list. As such, providers will now be reimbursed by Medicare for THA performed during a hospital outpatient stay. Medicare will continue to reimburse providers for THA as an inpatient procedure if the patient’s admission spans at least two midnights.

What is the CPT code for total hip arthroplasty?

Answer: The advice you received related to reporting this as a conversion to total hip arthroplasty is correct. The patient is not in a global period, so you will report 27132 (Conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft).

What is the difference between 27125 and 27236?

Code 27236 is assigned for hemiarthroplasty following fracture; code 27125 is assigned for hemiarthroplasty secondary to degenerative arthritis and other similar diseases and conditions.

What is CPT code C1776?

Code C1776 is also used for implantable devices of joints other than the knee. When a physician implants a device during an associated surgical procedure, and that device meets the definition above, report code C1776.

Is arthroplasty a major surgery?

Arthroplasty is a common but major surgery with significant risks and potential complications. You may have less invasive treatment options.

Is arthroplasty a diagnosis?

This clinical scenario can be frustrating to both the patient and the surgeon who is accustomed to good outcomes. A systematic evaluation of the patient and arthroplasty can lead to a definitive diagnosis of the cause of the patient’s symptoms.

What is the difference between 27130 and 27132?

Category 2 CPT codes are used for supplemental tracking and are optional, while category 3 CPT codes are provisional codes for new technologies, procedures, or services (17). For this study, CPT 27130 was used to identify primary THA, while CPT 27132 was used to identify conversion THA.

What is a femoral neck fracture?

Femoral neck fractures are a specific type of intracapsular hip fracture. The femoral neck connects the femoral shaft with the femoral head. The hip joint is the articulation of the femoral head with the acetabulum. The junctional location makes the femoral neck prone to fracture.

What is a Subcapital hip fracture?

The Femur: Part of the Hip Joint Most hip fractures occur just below the head of the thighbone. There are two common types: Femoral neck (subcapital) hip fractures, which occur in the neck of the thighbone. Intertrochanteric hip fractures, which go through the large bumps just below the neck.

When is CPT code 27130 removed from IPO list?

CMS removed CPT code 27130 (THA) from the IPO list. As such, providers will now be reimbursed by Medicare for THA performed during a hospital outpatient stay. Medicare will continue to reimburse providers for THA as an inpatient procedure if the patient’s admission spans at least two midnights.

When to use 27236 or 27130 for Tha?

You should use 27130 for THA regardless if it’s fracture or not, use 27236 only if it’s hemiarthroplasty to treat fracture. This was discussed and clarified by an orthopedic coding consultant Margie Scalley-Vaught at a specialty coding class I attended.

Is the CPT code 27130 the same as the TKA?

The procedure described by CPT code 27130 is fundamentally different from other procedures. CMS has proposed removing CPT code 27447 from the IPO in 2018. THA and TKA are similar in the extent of risks associated with each in moving the site of surgery to an outpatient setting.

What is CPT 27130 for hip arthroplasty?

CPT 27130 (THA) is proposed as a “device-intensive” code under OPPS—identified with payment indicator J8 and designated by CMS as having adjusted pricing attributable to implant cost. No additional implant payment would be made by Medicare to ASCs beyond the proposed rate of $8,923.98, which is based on the national unadjusted payment rate.

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