Frequently Asked Questions
Lumbar Spinal Fusion in ICD-10-PCS
ICD-10-PCS has a seven character alphanumeric code structure. A code is derived by choosing a specific value for each of the seven characters based on the details of the procedure performed. ICD-10-PCS codes for lumbar spinal fusion are built with the following code table (0SG) for fusion of the lower joints.
Section |
0 – Medical and Surgical |
---|
Body System |
S – Lower Joints |
Operation |
G – Fusion |
Given the first three characters of 0SG, you then select the appropriate 4th character Body Part, 5th character Approach, 6th character Device and 7th character Qualifier based on the details of the procedure.
Section |
0 – Medical and Surgical |
---|
Body System |
S – Lower Joints |
Operation |
G – Fusion |
Body Part |
Approach |
Device |
Qualifier |
---|
0 – Lumbar Vertebral Joint |
0 – Open |
7 – Autologous Tissue Substitute |
0 – Anterior Approach, Anterior Column |
1 – Lumbar Vertebral Joints, 2 or more |
3 – Percutaneous |
J – Synthetic Substitute |
1 – Posterior Approach, Posterior Column |
3 – Lumbosacral Joint |
4 – Percutaneous Endoscopic |
K – Nonautologous Tissue Substitute |
J – Posterior Approach, Anterior Column |
Z – No Device |
0 – Lumbar Vertebral Joint |
0 – Open |
A – Interbody Fusion Device |
0 – Anterior Approach, Anterior Column |
1 – Lumbar Vertebral Joints, 2 or more |
3 – Percutaneous |
|
J – Posterior Approach, Anterior Column |
3 – Lumbosacral Joint |
4 – Percutaneous Endoscopic |
|
For example, an L4-5 open approach posterolateral fusion with autograft is coded: 0SG0071. An L3-5 open approach posterior interbody fusion with an interbody fusion device is coded: 0SG10AJ. An L5-S1 open approach anterior interbody fusion with allograft is coded: 0SG30K0.
What if the procedure uses a combination of devices to obtain fusion like an interbody device with allograft?
ICD-10-PCS guideline B310c states: "Combinations of devices and materials are often used on a vertebral joint to render the joint immobile. When combinations of devices are used on the same vertebral joint, the device value coded for the procedure is as follows:
- If an interbody fusion device is used to render the joint immobile (alone or containing other material like bone graft), the procedure is coded with the device value for the interbody fusion device.
- If bone graft is the only device used to render the joint immobile, the procedure is coded with the device value nonautologous tissue substitute or autologous tissue substitute.
- If a mixture of autologous and nonautologous bone graft (with or without biological or synthetic extenders or binders) is used to render the joint immobile, code the procedure with the device value autologous tissue substitute."
What if multiple vertebral joints are fused?
ICD-10-PCS guideline B3.10b states that if multiple joints are fused, a separate procedure is coded for each vertebral joint that uses a different device and/or qualifier.
What about the insertion of spinal instrumentation?
The AHA Coding Clinic for ICD-10 3rd Quarter 2014 states "ICD-10-PCS general guideline B3.1b clarifies that components of a procedure specified in the root operation definition and explanation are not coded separately. The explanation in the root operation for fusion states ‘that body part is joined together by fixation device, bone graft, or other means.’ Therefore, the fixation (rods, plates, screws) is included in the fusion and no additional code is assigned."
How is the discectomy coded?
According to AHA Coding Clinic for ICD-10 2nd Quarter 2014, if a provider performs a discectomy with spinal fusion, it should be coded as excision of disc. If, however, the provider documents "total discectomy," it should be coded as disc resection. For example, 0SB20ZZ – Excision of lumbar vertebral disc with an open approach.
What about the excision of bone for grafting?
ICD-10-PCS guideline B3.9 states that if autograft is obtained from a different body part then a separate procedure is coded. For example, 0QB20ZZ – Excision of right pelvic bone with an open approach.
Do you report more than one fusion code when both the anterior and posterior columns of the spine are fused during a ‘360-degree’ fusion procedure?
Yes. More than one fusion code is required because there are different 7th character qualifiers for the anterior and posterior columns of the spine.
Can an interbody fusion device be reported for a posterior column fusion?
No. An interbody fusion device indicates that a fusion procedure is performed in the anterior column of the spine.
Does the insertion of posterior spinal instrumentation alone require the reporting of a posterior column fusion code?
No. Spinal fusion involves some type of bone graft or bone graft substitute. In addition, while the Z character (No Device) is currently available for spinal fusion PCS codes, the ICD-10 Coordination and Maintenance Committee intends to delete value ‘Z-No Device’ from tables 0RG and 0SG, Fusion of Upper Joints and Fusion of Lower Joints.
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