ICD-10 Coding for Hemiarthroplasty(S72.001A, M16.11)
Complete ICD-10-CM coding and documentation guide for Hemiarthroplasty. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Hemiarthroplasty
S72.0-S72.9Primary Range
Fracture of femur
Covers traumatic fractures of the femur, a common indication for hemiarthroplasty.
Osteoarthritis of hip
Includes degenerative conditions like osteoarthritis, which may necessitate hemiarthroplasty.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S72.001A | Fracture of unspecified part of neck of right femur, initial encounter | Use for traumatic femoral neck fractures requiring hemiarthroplasty. |
|
| M16.11 | Primary osteoarthritis, right hip | Use for non-traumatic degenerative conditions requiring hemiarthroplasty. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for hemiarthroplasty
Essential facts and insights about Hemiarthroplasty
Primary ICD-10-CM Codes for hemiarthroplasty
Decision Criteria
clinical Criteria
- Presence of a traumatic event leading to fracture
Applicable To
- Displaced femoral neck fracture
Excludes
- Pathological fracture
Clinical Validation Requirements
- X-ray or MRI confirming fracture
- Clinical documentation of trauma
Code-Specific Risks
- Incorrectly coding non-traumatic fractures
Coding Notes
- Ensure trauma is documented to justify the use of this code.
M16.11 - Primary osteoarthritis, right hip
Use for non-traumatic degenerative conditions requiring hemiarthroplasty.
Applicable To
- Degenerative joint disease
Excludes
- Traumatic arthritis
Clinical Validation Requirements
- Imaging showing joint space narrowing
- Documentation of pain and functional limitation
Coding Notes
Ensure degenerative condition is well-documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Hemiarthroplasty to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S72.001A.
Impact
Clinical: Ambiguity in treatment side, Regulatory: Non-compliance with coding standards, Financial: Potential claim denials
Mitigation Strategy
Always specify right or left in documentation
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use 27236 for fracture-related hemiarthroplasty.
Impact
Using codes for elective procedures in trauma cases
Mitigation Strategy
Regular training on code differentiation
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Hemiarthroplasty, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Hemiarthroplasty
Use these documentation templates to ensure complete and accurate documentation for Hemiarthroplasty. These templates include all required elements for proper coding and billing.
Hemiarthroplasty for femoral neck fracture
Specialty: Orthopedic SurgeryRequired Elements
- Indication for surgery
- Surgical approach
- Implant details
- Post-operative plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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