Manipulation under Anesthesia (MUA) for the Hip Joint and Pelvic Ring (27275 & 27194)

ChiroCode Hot Topics, March 2008

Subsequent to our January 2008 ChiroCode Hot Topics article for 22505-Manipulation Under Anesthesia, Any Region, we had some inquiries regarding coding helps for the hips and pelvis. Because MUA matters, and because it is a current national hot topic by subject matter experts (SME), this is our quest for truth about proper MUA codes for the hips (27275) and pelvis/pelvic ring (27194). Truly, “The defining of terms is the commencement of wisdom.” This article is focused on the definitions of two MUA procedures for coding purposes, and not upon any evidence of clinical efficacy or studies reported in literature for medical necessity.

History

During the past few years practitioners have been taught to bill for the following codes: 22505 for the spinal areas, and 27275 for the sacroiliac (SI ) joint/hip (with appropriate modifiers -LT and -RT). Lately, there has been a push to bill 27194 for the SI joint and lower extremity stretch/manipulation that is performed. The rationale is that 27194 is a better description. Some attorneys who represent the No Fault/Personal Injury litigations say that it easier for them to explain the 27194 code than the 27275 code.

Objective Findings

CPT codes and descriptions The most commonly used code by most MUA doctors for treatment to the spine is code is 22505 - Manipulation of spine requiring anesthesia, any region. Additionally, there are various MUA procedure codes for other regions of the body (e.g. upper and lower limbs). The CPT has unique and specific codes applicable for MUA to the hips and pelvic ring.

Hip Joint

When MUA is perform on the hip(s), the code is 27275 - Manipulation, hip joint, requiring general anesthesia.

Pelvic Ring

When MUA treatment is performed on the pelvic ring, it is 27194 - Closed treatment of pelvic ring fracture, dislocation, diastasis or subluxation; with manipulation, requiring more than local anesthesia.

When “more than local anesthesia” is required, 27194 accurately describes a procedure performed to the pelvic ring. Stedman’s Medical Dictionary, 28th Edition has these definitions:

Stedman’s CPT Dictionary, by the AMA, has these definitions:

Assessment

From the above findings, we learn that the pelvic ring includes the hips. Therefore, if a protocol is for treatment beyond just the hips, the “pelvic ring” 27194 code could be appropriate to use, providing that meets the non-local anesthesia requirement.

Many times, an accurate and exact code description does not exist, and going to the specific third-party payer could be an option. According to Lawrence Humberstone DC, “Payers might already have procedures and policies (i.e. technology assessments) to cover such issues, including clinical/medical necessity.”

Regarding attorney opinions: Support for one code or another could obviously vary according to the knowledge and communication ability of the lawyer on a case. Any comfort level by an attorney for a code is not relevant to the facts, and accordingly ought to be disregarded. Comfort with a code has nothing to do with its description for proper and accurate coding.

Plan

  1. Each MUA practitioner needs to review their protocol and determine if it meets the definition of 27194 , before using it for billing.
  2. Obtain opinions from respected SME consultants and payers on insurance coverage.
  3. Physicians' Current Procedural Terminology (CPT) is a registered trademark of the American Medical Association

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