This page addresses follow-up questions and additional information pertinent to our webinar
Straight to the Point: ICD-10-PCS Coding for Spinal Fusions.

** The coding information and guidance are valid at the time of publishing. Learners are encouraged to research
subsequent official guidance in the areas associated with the topic as they can change rapidly.

Q: Where does BMP fit in the classification of grafts and device values?
A: In ICD-10-PCS, BMP is not considered a device, so it’s not an option when choosing a device value. It doesn’t render joints immobile, but it does help stimulate bone production to aid the bone graft in taking hold.

Q: How do we apply the device hierarchy from ICD-10-PCS Guideline B3.10c?
A: If an interbody fusion device is used for the fusion, the procedure is coded with the device value “Interbody Fusion Device”. A graft is included, so if both an interbody fusion device and graft material is placed at a joint space, only the interbody fusion device is chosen as the “device” value.

Q: Can an interbody fusion device ever be inserted without graft material?
A: Technically, an interbody cage or spacer can certainly be inserted without any type of bone graft material. But if that is the case, the procedure would be considered an Insertion instead of a Fusion. To be considered a fusion, there must be some form of bone graft or substitute being used.

Q: You said that if a patient is placed in the prone position (face down) that it would almost always be considered a posterior approach. What about a transpsoas lateral interbody fusion? Patients are placed prone for that approach, but the approach states lateral and the anterior column is treated.
A: Per Coding Clinic notes, the prone transpsoas lateral interbody fusion approach is a form of XLIF which is an anterior approach. Only the posterior or posterolateral approaches (incisions on the back of the body) are considered posterior approaches.