Billing and Coding: Total Joint Arthroplasty

This billing and coding guidance aligns with LCD L39911: Total joint arthroplasty (hip or knee) is covered when advanced joint disease is documented by imaging and when pain/functional disability and unsuccessful conservative therapy (usually ≥3 months) support the need for surgery. Documentation requirements are strict—medical records must be legible, signed, support ICD-10 and CPT coding, document imaging findings, conservative treatment history, risk/benefit for comorbidities, and for infection or bilateral procedures include specific lab/pathology and modifier documentation; non-covered services must be billed with appropriate modifiers.

"Total hip or knee arthroplasty (TJA/TKA/THA) is indicated for advanced joint disease when arthritis of the knee or hip is documented by X-ray or MRI showing subchondral cysts, subchondral sclerosis..."

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