These key terms make coding for hip procedures easier and more accurate.
If you think your hip is that thing jutting out at you in the mirror, your nomenclature needs a rehaul to ensure you’re nailing the correct codes. Coding for hip fractures and other procedures is easier when the coder is hip to the anatomy and terminology.
Common mistake: The average person refers to the prominent part of the pelvis that juts out just below the waistline (the iliac crest) as the hip. However, the hip portion of the pelvis is really about five inches below and is called the acetabulum, or “true hip.”
The ABCs of Hip Anatomy
Hip joint: Three areas of the pelvic structure form the acetabulum or the socket: the ilium, the ischium, and the pubis.
Femoral head: This is the “ball,” which is located in the upper end of the femur. The femoral head and the acetabulum are covered with a layer of cartilage that provides shock absorption and load distribution within the hip.
Femoral neck: The area below the femoral head where the bone narrows into a tubelike structure about two inches long.
Greater and lesser trochanters: These are part of the femur located just distal to the femoral neck where the bone widens into two large prominences. “Intertrochanteric” refers to any region between the two trachanters and “subtrochanteric” refers to the widened part of the shaft just below the lesser trochanteric.
Bigelow ligament (anterior iliofemoral ligament): This ligament covers the femoral neck and the ligament teres, which is the round ligament between the middle of the femoral head and the center of the acetabulum.
Adductor muscles: This group of five muscles pulls the thigh inward. They include the adductor magnus, adductor longus, adductor brevis, pectineus, and the gracilis muscles.
Internal and external rotators muscles: These include the obturator gemelli, quadratus femoris, the piriformis, the gluteus maximus, gluteus medius, gluteus minimus, iliopsoas,rectus femoris, satrius, and the tensor fascia lata muscle.
Arteries: These include the femoral artery, inferior gluteal artery, obturator artery, and the superior gluteal artery.
Nerves: Three large nerves pass near the hip. They are the femoral nerve, the obturator nerve and the sciatic nerve.
Code Treatment Type, not Fracture Type
When coding for hip fracture repair, make sure that you understand the three different repair methods: closed, open, and percutaneous. Per CPT, fracture care is described by the type of treatment rendered — not by the fracture type. The repair methods are defined as follows:
Closed treatment: The fracture site is not surgically opened and can be performed with or without manipulation, or with or without skeletal or skin traction.
Open treatment: Refers to the requirement for a surgical incision to expose the fracture for direct visualization or opened remotely to insert an intramedullary nail across the fracture site. Internal and/or external fixation may be applied.
Percutaneous: (Latin per, through, + cutis, skin): Treatment is affected through the skin. Treatment is neither open nor closed. Some fractures can be set percutaneously. The physician performs percutaneous skeletal fixation through a small stab incision, usually with the aid of fluoroscopy.
Test Your Terminology
It’s important for coders to recognize common terms and eponyms. Not all op notes are created equal — what one doctor reports as a femoral head-neck junction fracture may be simply referred to as a “subcapital” by another. Familiarize yourself with the following:
Basal neck: Fracture of the base of the femoral neck at the junction of the trochanteric region
Dashboard: Fracture of the posterior lip of the acetabulum chips when the femoral head is driven against it
Extracapsular: Fracture located outside the joint capsule
Femoral neck: Transcervical fracture through the mid portion of the femoral neck
Intertrochanteric: Fracture along a line joining the greater and lesser trochanters
Mallory: Femoral shaft fractures occurring during total hip replacement
Pauwels classification: Refers to the angle the fracture makes with the horizontal
Pertrochanteric: Fracture involving the proximal femur where the fracture line passes through both the lesser and greater trochanters
Pipkin: Based on the location of the fracture head and neck when associated with a posterior hip dislocation
Subcapital: Femoral fracture at the head-neck junction
Subtrochanteric: Transverse fracture of the femur just below the lesser trochanteric.
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Our Guest Columnist, Susan Vogelberger, CPC, CPC-H, CPC-I, CMBS, CCP-P, has more than 18 years of experience in healthcare coding and reimbursement. She is the CEO and owner of Healthcare Consulting & Coding Education, LLC, located in northeast Ohio, which provides auditing,consulting, and educational services to facilities, physician offices, hospitals, and accounting firms. Susan has performed numerous audits reviewing hundreds of medical records for documentation, medical necessity, and correct coding. She also specializes in compliance and is knowledgeable and proficient in all areas of coding, reimbursement, and government regulation. Susan has authored numerous articles that have been published in leading coding and billing magazines and is a certified Professional Medical Coding Curriculum (PMCC) instructor and presenter of workshops and seminars.
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