Billing and Coding: Total Hip Arthroplasty

Total hip arthroplasty is covered when medical records document hip arthritis with corroborating imaging findings, hip pain or functional disability (e.g., ADL impairment), and a reasonable trial of conservative therapy when appropriate; additional indications include joint malignancy, fracture, revision for pain, and infected revisions with supporting labs/pathology. Coverage requires complete documentation (H&P, discharge summary, progress notes, operative report, imaging, treatment history, and infection/malignancy reports when applicable), demonstration that inpatient care was necessary when billed as inpatient, and use of implants consistent with FDA device regulations; insufficient or missing documentation may result in denial.

"Total hip arthroplasty (THA) is covered for advanced hip joint disease when hip arthritis is documented by X-ray, MRI, or CT demonstrating one or more of: subchondral cysts, subchondral sclerosis, ..."