Bearing Surface Vol.3 Codes
Q. We are
having a problem in trying to use the new ICD-9 CM procedure codes for hip
replacement bearing surfaces: 00.74, 00.75, and 00.76. While we understand that the bearing surfaces
involve the materials used for the femoral heads and the liners or inserts
within the acetabular shells that articulate with these femoral head
components, our surgeons often fail to identify these materials in the
operative reports, forcing us to search for the product stickers in the chart
or to go on the manufacturer’s website to find the information we need. Is there any centralized resource that we can
go to that lists the names of the major metal, polyethylene, and ceramic
components available for hip replacement as well as the names of the
manufacturers who produce these components.
That would save us a lot of time.
A. To the best of our knowledge, there is no
centralized resource that does exactly what you request. As an attempt to remedy this situation, we
have a compiled a list below of the most commonly used manufacturers and their
bearing surface products matching them to the materials described in the new
ICD-9 CM procedure codes:
replacement bearing surface, metal on polyethylene
Endo II cobalt chrome femoral head
Modular cobalt chrome femoral head
Offset cobalt chrome femoral head
ArCom polyethylene liners
highly cross-linked polyethylene liners
Articuleze cobalt chrome femoral heads
Marathon cross-linked polyethylene liners
Cobalt chrome femoral heads
Millennium cross-linked polyethylene liners
Cobalt chromium femoral heads
Smith & Nephew
Cobalt chrome femoral heads
Reflection polyethylene liners
Reflection XLPE (cross-linked polyethylene
C-Taper cobalt chrome femoral heads
LFIT (Low Friction Ion Treatment) cobalt
chromium femoral heads
V40 Vitallium femoral heads
Crossfire XLPE (highly cross-linked
Trident constrained polyethylene inserts
Trident Eccentric polyethylene inserts
Continuum superpolished 12/14 femoral heads
6 degree taper cobalt chrome femoral heads
Versys 12/14 cobalt chrome femoral heads
Durasul polyethylene liners
Epsilon Durasul constrained polyethylene
Longevity highly cross-linked polyethylene
replacement bearing surface, metal-on-metal
Ultamet Metal-on-Metal Articulation
Conserve Total Hip System with BFH Technology
Transcend Metal-on-Metal Articulation System
replacement bearing surface, ceramic-on-ceramic
Biolox delta ceramic femoral heads
forte ceramic femoral heads
Biolox delta ceramic cup inserts
Biolox forte ceramic cup inserts
Depuy Orthopedics, Inc. (depuy.com)
Duraloc Option Ceramic Hip System (using
Encore Medical (encoremed.com)
Keramos Acetabular System (using alumina ceramic
heads and liners)
Zirconia and alumina ceramic heads
Smith & Nephew
Reflection Ceramic Acetabular System
C-Taper alumina ceramic femoral heads
V40 alumina ceramic femoral heads
Trident Ceramic Acetabular System
alumina ceramic heads
Ceramic Hip Articulation System
October 1, 2006, code 00.77 has been added to capture ceramic-on-polyethylene
bearing surface. The same brand name ceramic heads listed under 00.76 and the
same brand name polyethylene liners listed under 00.74 would apply to this new
code. Smith & Nephew has developed a
new hybrid femoral head component made of oxinium, a zirconium metal alloy base
treated with oxygen to create a ceramic bearing surface of zirconium
oxide. The oxinium femoral head can be
combined with the company's Reflection XLPE to provide another example of a
ceramic-on-polyethylene bearing surface.
Coders should bear
in mind that the above list is not intended to be exhaustive, but merely to
serve as a general reference describing what bearing surfaces are currently
available. In addition to the manufacturers’
websites mentioned above, coders should regularly consult activejoints.com,
a site that keeps track of the latest orthopedic components to receive FDA
approval or to be involved in ongoing clinical trials. Totaljoints.info is another valuable
website featuring helpful discussions of joint replacement components and the
relative benefits and drawbacks of each of the materials currently in use.
WHAT IS A DIAGNOSIS RELATED GROUP (DRG)?
grouping of disease and disorders into medically meaningful sets as developed
for Medicare & Medicaid Services (CMS).
reimbursement system consists of established payment levels for groupings of
according to medically meaningful characteristics. There are six major
utilized in assigning a particular admission to a specific DRG. These consist
performed on the patient
diagnoses, complications or comorbid conditions.
WHAT IS A MAXIMUM ALLOWABLE PAYMENT (MAP)?
allowable amount payable for services provided to BCBSKS members. For hospital
claims, the allowable amount is typically based on a DRG assignment.
to the 8/22/07 Final Rule (page 47142), CMS chose MS-DRGs over the other
remains an improvement over the current CMS DRGs;
are more up-to-date (in relation to the review of MCCs &
are available in the public domain;
will have fewer transition issues than other systems; and
allow for updates and maintenance to continue using the same
as under the current CMS DRGs.
Cross and Blue Shield of Kansas (BCBSKS) has always utilized the standard
grouper for establishing the maximum allowable payment (MAP) for inpatient
So, when Medicare decided to move towards the MS-DRGs, BCBSKS followed
established their MAPs based on the MS-DRG (Version 25.0) grouper.
choosing the MS-DRG grouper, BCBSKS is able to incorporate ICD-9-CM diagnosis
procedure codes revisions into their payment structure.
grouper is a computer program or module which takes the five clinical and
data as input and gives a corresponding diagnosis related group (DRG) as
grouper that was used in 2007 for the CMS DRGs was version 24.0. This
categorizes ICD-9-CM diagnosis and procedure codes to CMS-DRGs.
grouper that is being used in 2008 for the MS-DRGs is version 25.0. This
categorizes ICD-9-CM diagnosis and procedure codes to MS-DRGs. Beginning
BCBSKS will be using version 26.0.
ABG: Arterial blood gases. A test where
blood is drawn and measured for oxygen content. The ABG tells the
physician whether or not the patient is getting enough oxygen into the
bloodstream. An ABG is frequently used for cases of asthma, COPD, or
Adenosine: A drug used to treat certain heart
arrhythmias (irregular heartbeats) by helping to stabilize heart rhythm.
(see IV push)
AMA: Against Medical Advice. a term
used with a patient who checks himself out of a hospital
against the advice of a person's doctor. While it may not be medically wise for
the person to leave early, in most cases the wishes of the patient are
considered first. The patient is usually asked to sign a form stating that he
is aware that he or she is leaving the facility against medical advice, and the
AMA term is used on reports concerning the patient. This is for legal reasons
in case there are complications to limit liability on the part of the medical
Angioplasty: A surgical procedure in which a small
catheter with a balloon tip is threaded into the coronary artery. The
balloon is then blown up to re-expand the clotted artery.
Arrhythmia: occurs when the beat of the heart is no
longer originating from the sinus node, and the rhythm is abnormal.
Atropine: A drug used to speed up the heart rate.
AZT: an antiviral drug prescribed for the
treatment of AIDS.
Bagging: a procedure in which a bag is
attached outside the mouth so that breathing can be done mechanically for the
BP: abbreviation for blood pressure.
Blood culture: A test where blood is drawn and cultured
for bacteria. It is usually ordered when someone has a high fever,
particularly a young child, to identify the organism causing the disease and
treat it with the proper antibiotic.
Blood gases: A test that determines the oxygen and
carbon dioxide levels in the blood, as well as the pH.
Brady Cardia: very slow heart rate.
Bradying Down: Heart rate is dropping.
Cardiac enzymes: A damaged heart muscle
releases enzymes over a period of time and, by drawing cardiac enzymes, it is
possible to confirm that a heart attack has taken place. (see coag
Cath lab: Short for catheterization laboratory,
where a cardiologist performs angioplasty.
CBC: abbreviation for Complete Blood Count.
CC: abbreviation for Chief complaint.
Chem 7: A blood test that measures the basic
electolytes in blood: sodium, chloride, potassium, carbon dioxide, blood urea
nitrogen (BUN), creatinine, and glucose. A chem 7 is useful in the
assessment of many diseases, as derangement of these elements can be
fatal. (see coag panel)
Chest: Short for chest X ray, typically done
when the doctor suspects pneumonia or to rule out pneumonia.
CHF: abbreviation for Congestive Heart
C-section: shorthand for cesarean section, which is
the surgical delivery of a baby through the abdominal wall.
Coag panel: An assessment of how well the blood is
Code brown: term used when a patient doesn't make it
to the bathroom in time and has a bowel movement.
COPD: abbreviation for Chronic obstructive
Crike: when the throat is cut to insert a
direct tube for breathing when a intubation is not possible due to blockage of
Crit (hematocrit): A test to measure the number
of red blood cells in the blood - the level of which typically decreases when a
person has been bleeding or has anemia. (see platelets)
Cystic fibrosis: a lung disease that causes
the production of thick mucus in the lungs, hampering breathing.
Diaphoresis: Sweaty skin associated with an MI.
DOA: abbreviation for dead on arrival.
Dopamine: A drug that makes the heart pump more
Down: Slang expression for Cardiac arrest.
"The patient's down!"
DNR: abbreviation for Do not resuscitate;
often requested or ordered for terminally ill patients.
Edema: excessive accumulation of fluid.
EKG (ECG): abbreviation for electrocardiogram;
measures heart activity.
EMT: abbreviation for Emergency Medical
Endotracheal tube: an instrument inserted into
the trachea through the mouth to facilitate breathing.
Gastric Lavage: Method used to pump stomachs
after drug overdose.
Hemorrhage: a dramatic and sudden loss of blood.
Hyperresonant: When percussing (thumping) a patient's
back and listening for breath sounds, the doctor will hear hyperresonant, or
increased, vibrations that are indicative of a pneumothorax. (see
Hypertension: High blood pressure.
Hypotension: Low blood pressure.
Intubation: the procedure of inserting a tube into
the trachea of a patient who is not breathing.
Intubation tray: A tray that contains various
instruments used to intubate a patient who is not breathing: a laryngoscope,
which is an instrument for opening the larynx; and an endotracheal tube, which
is inserted into the trachea through the mouth to facilitate breathing. A
bag is attached outside the mouth so that breathing can be done mechanically
for the patient - in a procedure known as "bagging."
IV push: When a drug is put directly into the IV
all at once.
Large-bore IV: An IV with a large needle used to
transfuse fluids - either saline or blood - very quickly, particularly in
trauma cases, where a patient may have lost a lot of blood.
Laryngoscope: an instrument for opening the larynx.
Lavage: Washing out. A gastric lavage, for
example, involves removing the bad drugs from an overdose by washing out the
stomach, giving charcoal afterward, and managing the adverse side
effects. A peritoneal lavage is a test for abdominal bleeding wherein
blood is washed out of the abdominal cavity.
Lidocaine: An Anti-Arrythmic drug used to help stop
LOC: abbreviation for Level of consciousness
or loss of consciousness.
LP:A lumbar puncture, sometimes called a
spinal tap, is a procedure in which a small amount of the fluid that surrounds
the brain and spinal cord, called the cerebrospinal fluid (CSF), is removed and
MI: abbreviation for Myocardial infarction
(heart attack). (see ST wave)
MVA: abbreviation for Motor Vehicle Accident.
Normal saline: Saline solution that has the same
balance as the fluids in the body. Saline is administered when the
patient requires fluids due to dehydration or when nothing may be taken by
mouth because of the possibility of impending surgery.
Pericardiocentisis: A procedure where they insert
a syringe into the chest and drain the fluid from the pericardium.(which is the
sack around your heart.
Peritoneal Lavage: A procedure done to
check for internal bleeding in the abdomen following a trauma.
Platelets: The factors in the blood that cause
Preemie: A slang expression for a premature
Pronounce: an expression for pronouncing a
Pulmonary edema: fluid in the lungs.
Pulse Oximetry ("pulse ox"): a non-invasive and painless
way to measure the oxygen saturation of arterial blood. Also an indicator of
how well someone's breathing; healthy range is between about 96 and 100.
PVC (Premature Ventricular Contraction): one of the most common
Rape kit: a package containing envelopes for the
collection of hair, sperm, and blood samples of a rape victims, as well as the
official reporting forms.
Saline solution: a blood volume substitute
made of salt and water, a temporary substitute for lost blood.
SIDS: Sudden infant death syndrome is any
sudden and unexplained death of an apparently healthy infant aged one month to
one year. The term cot death is sometimes used in the United Kingdom, and crib
death in North America.
Sinus rhythm: Normal heartbeat.
ST wave: On a heart monitor, one heartbeat is
reflected as a PQRST wave. A segment of the wave is the ST.
Stat: Slang expression for hurry up.
STD: abbreviation for sexually transmitted
SVT: Supra Ventricular Tachycardia - A
Tachycardia (Tachy): rapid heart rate.
Tension pneumo: Short for tension pneumothorax. It
is a collapsed lung where air escapes into the chest every time the patient
breathes, as if through a one-way valve. A tension pneumo can cause
pressure on the heart and is a serious emergency.
Thoracotomy: A procedure done by opening the chest
usuing a rib spreader to have direct access to the heart if the patient is in
asytole, (flat line on the monitor). Then they will do internal cardiac
massage, which is rubbing the heart. Because you never defibrillate
Throat swab: A throat swab is the same as a throat
culture and is used to test for Streptococcus.
Tox Screen/RUDS: Blood test to determine what
drugs are in a patient's system. RUDS is short for Random Urine Drug
Triage: the system of prioritizing patients in
an emergency situation in which there are a great number of injured or ill.
TPA: A powerful drug used to dissolve a blood
clot in the coronary artery that is causeding a heart attack. (see angioplasty)
V-fib: Ventricular Fibrillation, one of
the dangerous cardiac arrythmias.
V-tach: When the heart is beating at an
abnormally high rate.
White count: A test to measure the number of white
blood cells in the blood. The white cells are the blood cells that fight
infection, and an increased count usually indicates the presence of an
infection. (see platelets)