ICD-10-PCS: Total Hip Arthroplasty &Hemiarthroplasty

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April 21, 2015

What is a total hip arthroplasty (THA)?Total hip arthroplasty, or surgical replacement of the hip joint with an artificial prosthesis, is a reconstructive procedure that has improved the management of those diseases of the hip joint that have responded poorly to conventional medical therapy. • This codes to Root operation “Replacement”

Hip replacement surgery can be performed as a total replacement or a hemi (half) replacement. A total hip arthroplasty consists of replacing both the acetabulum and the femoral head while a hemiarthroplasty generally only replaces the femoral head. • The body system being replaced is “Lower Joints”

In a total hip arthroplasty, the damaged bone and cartilage is removed and replaced with prosthetic components. The damaged femoral head is removed and replaced with a metal stem that is placed into the hollow center of the femur. The femoral stem may be either cemented or "press fit" into the bone. A metal or ceramic ball is placed on the upper part of the stem. This ball replaces the damaged femoral head that was removed. The damaged cartilage surface of the socket (acetabulum) is removed and replaced with a metal socket. Screws or cement are sometimes used to hold the socket in place. A plastic, ceramic, or metal spacer is inserted between the new ball and the socket to allow for a smooth gliding surface.Upon inserting the prosthesis into the central core of the femur, it is fixed with a bone cement called methylmethacrylate. Conversely, a "cementless" prosthesis may be used that has microscopic pores which allow bony ingrowth from the normal femur into the prosthesis stem. This "cementless" hip is felt to have a longer duration and is considered especially for younger patients.

What does the coder need to know? • Which hip is being replaced (laterality) • Is the replacement total or partial. • If partial, which component is being replaced • Acetabular • Femoral • What is the replacement made of? This will code to the “Device” left

after the surgery • Metal • Metal on Polyethylene • Ceramic • Ceramic on Polyethylene • Other • Is the replacement cemented in place? This will determine the

Qualifier.

Brief Example of a THA Procedure:Total hip replacement, left hip. XYZ System (metal on polyethylene) utilized, a 50-mm outside diameter cup, 28-mm head, 12-mm femoral stem with a standard length neck, cemented. 0SRB029

What does the coder know in this case?

• Which hip is being replaced (laterality) - Left • Is the replacement total or partial? - Total • What is the replacement made of? - Metal on Polyethylene • Is the replacement cemented in place? - Yes

Vol. 10

ICD-10-PCS IndexReplacement Joint Hip Left 0SRB Acetabular Surface 0SRE Femoral Surface 0SRS Right 0SR9ICD-10-PCS Tabular

Brief Example of a Hemiarthroplasty Procedure:Left hip, cemented, hemiarthroplasty of the femur utilizing metal component. 0SRS019

What does the coder know in this case?

• Which hip is being replaced (laterality) - Left • Is the replacement total or partial? – Partial • If partial, which component is being replaced - Femoral • What is the replacement made of? - Metal • Is the replacement cemented in place? - Yes

ICD-10-PCS IndexReplacement Joint Hip Left 0SRB Acetabular Surface 0SRE Femoral Surface 0SRSICD-10-PCS Tabular

Note: The coder must be guided by documentation in the medical record of each individual case to make the correct code selections.

SectionBody SystemOperation

Medical and SugicalLower JointsReplacement: Putting in or on biological or synthetic material that physically

takes the place and/or function of all or a portion of a body part

0SR

0 Open9 CementedA UnCementedZ No Qualifer

1 Synthetic Substitute, Metal2 Synthetic Substitute, Metal on Polyethylene3 Synthetic Substitute, Ceramic4 Synthetic Substitute, Ceramic on PolyethyleneJ Synthetic Substitute7 Autologous Tissue SubstituteK Nonautologous Tissue Substitue

9 Hip Joint, RightB Hip Joint, Left

Body Part Approach Device Qualifier

9 Hip Joint, RightB Hip Joint, Left 0 Open Z No Qualifer

SectionBody SystemOperation

Medical and SugicalLower JointsReplacement: Putting in or on biological or synthetic material that physically

takes the place and/or function of all or a portion of a body part

0SR

0 Open

9 CementedA UnCementedZ No Qualifer

1 Synthetic Substitute, Metal3 Synthetic Substitute, CeramiicJ Synthetic Substitute

R Hip Joint, Fermoral Surface, RightS Hip Joint, Fermoral Surface, Left

Body Part Approach Device Qualifier

R Hip Joint, Fermoral Surface, RightS Hip Joint, Fermoral Surface, Left 0 Open Z No Qualifer

7 Autologous Tissue SubstituteK Nonautologous Tissue Substitue

The ICD-10 Fun Corner

Anthelio's ICD-10-PCS Word Scrambler

Directions: Please unscamble the words listed below

Root Operation

Answers are on the next page

1. NIICOXES

2. CEEISRONT

3. TCHNMDTAEE

4. STODCUNRITE

5. TNITRXOACE

6. IOINDVIS

7. LEEAERS

8. FUNSIO

9. TTEOAAILNR

10. AROTEICN

© 2015 Anthelio Healthcare Solutions Inc. Proprietary and confidential. All Rights Reserved. www.antheliohealth.com

The ICD-10 Fun Corner

© 2015 Anthelio Healthcare Solutions Inc. Proprietary and confidential. All Rights Reserved. www.antheliohealth.com

E X C I S I O N1. NIICOXES

2. CEEISRONT

3. TCHNMDTAEE

4. STODCUNRITE

5. TNITRXOACE

6. IOINDVIS

7. LEEAERS

8. FUNSIO

9. TTEOAAILNR

10. AROTEICN

D E T A C H M E N T

Anthelio's ICD-10-PCS Word Scrambler

Directions: Please unscamble the words listed below

Root Operation

R E S E C T I O N

D E S T R U C T I O N

E X T R A C T I O N

D I V I S I O N

R E L E A S E

F U S I O N

A L T E R A T I O N

C R E A T I O N