ICD-10 Coding for Hip Surgery(M16.11, 27130)
Complete ICD-10-CM coding and documentation guide for Hip Surgery. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Hip Surgery
M16.0-M16.9Primary Range
Osteoarthritis of hip
Primary range for coding osteoarthritis leading to hip surgery.
Presence of artificial hip joint
Used for documenting the status of hip prosthesis post-surgery.
Mechanical complication of internal joint prosthesis
Relevant for complications following hip replacement surgery.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M16.11 | Unilateral primary osteoarthritis, right hip | Use when documenting primary osteoarthritis of the right hip requiring surgery. |
|
| 27130 | Total hip arthroplasty | Use for coding total hip replacement procedures. |
|
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 total hip arthroplasty
Essential facts and insights about Hip Surgery
Primary ICD-10-CM Codes for hip surgery
Decision Criteria
clinical Criteria
- Radiographic evidence of osteoarthritis
documentation Criteria
- Detailed history of failed conservative treatments
Applicable To
- Primary osteoarthritis of right hip
Excludes
- Post-traumatic osteoarthritis (M16.5-)
Clinical Validation Requirements
- Radiographic evidence of joint space narrowing
- Failed conservative management
Code-Specific Risks
- Ensure laterality is correctly documented.
Coding Notes
- Ensure documentation supports the diagnosis with imaging and clinical findings.
27130 - Total hip arthroplasty
Use for coding total hip replacement procedures.
Applicable To
- Total hip replacement
Excludes
- Partial hip replacement (27125)
Clinical Validation Requirements
- Surgical report detailing both acetabular and femoral component replacement
Coding Notes
Ensure surgical documentation specifies total replacement.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Presence of right artificial hip joint
Z96.641Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Hip Surgery to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M16.11.
Impact
Clinical: Ambiguity in treatment site, Regulatory: Non-compliance with coding standards, Financial: Potential claim denials
Mitigation Strategy
Always specify right or left in documentation, Use templates that prompt for laterality
Impact
Reimbursement: Potential underpayment for the procedure., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Verify surgical report for both acetabular and femoral component replacement.
Impact
Insufficient documentation of conservative treatment failures.
Mitigation Strategy
Implement thorough documentation protocols.
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 Hip Surgery, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Hip Surgery
Use these documentation templates to ensure complete and accurate documentation for Hip Surgery. These templates include all required elements for proper coding and billing.
Total Hip Arthroplasty
Specialty: Orthopedic SurgeryRequired Elements
- Patient history
- Physical examination findings
- Imaging results
- Operative details
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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