HIP Replacement

HIP Replacement 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:

00.74  Hip replacement bearing surface, metal on polyethylene

Biomet (biomet.com)

       Endo II cobalt chrome femoral head

       Modular cobalt chrome femoral head

       Offset cobalt chrome femoral head

       ArCom polyethylene liners

       ArComXL highly cross-linked polyethylene liners

DePuy Orthopedics, Inc. (depuy.com)

       Articuleze cobalt chrome femoral heads

       Enduron polyethylene liners

       Marathon cross-linked polyethylene liners

Hayes Medical (hayesmed.com)

       Cobalt chrome femoral heads

       Millennium cross-linked polyethylene liners

Plus Orthopedics (plusortho.com)

       Cobalt chromium femoral heads

Smith & Nephew (smith-nephew.com)

       Cobalt chrome femoral heads

       Reflection polyethylene liners

       Reflection XLPE (cross-linked polyethylene liners)

Stryker Corporation (stryker.com)

       C-Taper cobalt chrome femoral heads

       LFIT (Low Friction Ion Treatment) cobalt chromium femoral heads

       V40 Vitallium femoral heads

       Crossfire XLPE (highly cross-linked polyethylene liners)

       Trident constrained polyethylene inserts

       Trident Eccentric polyethylene inserts

       X3 polyethylene liners

Zimmer (zimmer.com)

       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 inserts

       Longevity highly cross-linked polyethylene liners

00.75  Hip replacement bearing surface, metal-on-metal

Biomet (biomet.com)

       M2a – Magnum System

       M2a- Taper System

DePuy Orthopedics, Inc. (depuy.com)

       Ultamet Metal-on-Metal Articulation

Encore Medical (encoremed.com)

       Encore Large Metal/Metal

Wright Medical Technology (wmt.com)

       Conserve Total Hip System with BFH Technology

       Transcend Metal-on-Metal Articulation System

Zimmer (zimmer.com)

       Metasul Metal-on-Metal

00.76  Hip replacement bearing surface, ceramic-on-ceramic

CeramTec (ceramtec.com)

       Biolox delta ceramic femoral heads

       Biolox  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 CeramTec components)

Encore Medical (encoremed.com)

       Keramos Acetabular System (using alumina ceramic heads and liners)

Hayes Medical (hayesmed.com)

       Zirconia and alumina ceramic heads

Smith & Nephew (smith-nephew.com)

       Reflection Ceramic Acetabular System

Stryker (stryker.com)

       C-Taper alumina ceramic femoral heads

       V40 alumina ceramic femoral heads

       Trident Ceramic Acetabular System

Wright Medical Technology (wmt.com)

       Lineage alumina ceramic heads

       Lineage ceramic liners

       Transcend Ceramic Hip Articulation System

Effective 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.

  

MS-DRG

WHAT IS A DIAGNOSIS RELATED GROUP (DRG)?

A grouping of disease and disorders into medically meaningful sets as developed by the

Centers for Medicare & Medicaid Services (CMS).

This reimbursement system consists of established payment levels for groupings of

patients according to medically meaningful characteristics. There are six major criteria,

which are utilized in assigning a particular admission to a specific DRG. These consist

of:

- Patient's principal diagnosis

- Procedures performed on the patient

- Patient's age

- Patient's gender

- Patient's discharge status

- Multiple diagnoses, complications or comorbid conditions.

WHAT IS A MAXIMUM ALLOWABLE PAYMENT (MAP)?

The allowable amount payable for services provided to BCBSKS members. For hospital

inpatient claims, the allowable amount is typically based on a DRG assignment.

WHY MS-DRGs?

According to the 8/22/07 Final Rule (page 47142), CMS chose MS-DRGs over the other

DRG systems because:

- MS-DRGs remains an improvement over the current CMS DRGs;

- MS-DRGs are more up-to-date (in relation to the review of MCCs &

CCs);

- MS-DRGs are understandable;

- MS-DRGs are available in the public domain;

- MS-DRGs will have fewer transition issues than other systems; and

- MS-DRGs allow for updates and maintenance to continue using the same

process as under the current CMS DRGs.

Blue Cross and Blue Shield of Kansas (BCBSKS) has always utilized the standard

Medicare grouper for establishing the maximum allowable payment (MAP) for inpatient

claims. So, when Medicare decided to move towards the MS-DRGs, BCBSKS followed

and established their MAPs based on the MS-DRG (Version 25.0) grouper.

By choosing the MS-DRG grouper, BCBSKS is able to incorporate ICD-9-CM diagnosis

and procedure codes revisions into their payment structure.

WHAT IS A DRG GROUPER?

A DRG grouper is a computer program or module which takes the five clinical and

demographic data as input and gives a corresponding diagnosis related group (DRG) as

output.

The DRG grouper that was used in 2007 for the CMS DRGs was version 24.0. This

grouper categorizes ICD-9-CM diagnosis and procedure codes to CMS-DRGs.

The DRG grouper that is being used in 2008 for the MS-DRGs is version 25.0. This

grouper categorizes ICD-9-CM diagnosis and procedure codes to MS-DRGs. Beginning

10/1/08, BCBSKS will be using version 26.0.

ER/ED Abbreviations

ER/ED Abbreviations

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 chest trauma.

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 facility.

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 patient.

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 panel)

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 Failure.

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 coagulating.

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 pulmonary disease.

CPR: CardioPulmonaryResuscitation

Crike: when the throat is cut to insert a direct tube for breathing when a intubation is not possible due to blockage of the throat.

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 strongly.

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 Technician.

Endotracheal tube: an instrument inserted into the trachea through the mouth to facilitate breathing.

Gastric Lavage: Method used to pump stomachs after drug overdose.

GSW: Gun shot wound.

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 tension pneumo)

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 an arrythmia.

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 examined.

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 clotting.

Preemie: A slang expression for a premature infant.

Pronounce: an expression for pronouncing a patient's death.

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 arrhythmias

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 disease.

SVT:  Supra Ventricular Tachycardia - A cardiac arrythmia.

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 Asytole.

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 Screen.

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)