Please Note: Screen 44 in the live presentation showed code 00NW0ZZ for release of the spinal cord twice. It should only be listed once. Code 01N10ZZ for release of the cervical spinal nerve should also be assigned.
Q: If he said he used the mix of bone graft, bone marrow, and Kinex, do you code those differently? Meaning, 1 is autograft and Kinex isn’t.
A: No, the Kinex is not coded separately. Per ICD-10-PCS guideline B10.3x, “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.” Kinex is a bone extender and is considered integral to the autologous bone/bone marrow.
Q: I’m confused about the codes for case 3, both your codes say posterior approach. So why is it both?
A: In this case, both the anterior and posterior columns were fused (360-degree fusion), but the spine was only approached from the back. The codes include fusion of the anterior and posterior columns of the spine from a posterior The qualifier character captures both the column (anterior/posterior) and surgical approach (anterior/posterior), so be sure you are differentiating the two. In the codes for this case, the surgical approach is underlined while the spinal column is italicized.
| L3-4, L4-5 Anterior column fusion (posterior approach) | 0SG10AJ, Fusion 2-4 lumbar joints w/ interbody fusion device, posterior approach anterior column, open |
| L3-4, L4-5 Posterior column fusion (posterior approach) | 0SG1071, Fusion 2-4 lumbar joints w/ autologous substitute, posterior approach posterior column, open |
Q: L3-L4 Anterior Lumbar interbody fusion performed and posterior instrumentation at L3-4, can we code instrumentation separately for posterior incision?
A: No, instrumentation is always considered integral to the fusion and is never coded separately.
Q: What if they do a corpectomy for a vertebral tumor prior to fusion? Wouldn’t that be separately reportable procedure since it has a different intent than just a fusion.
A: When corpectomy is performed to remove a vertebral tumor, a code for removal of the bone (Excision or Resection) should be used. According to ICD-10-PCS guidelines, B3.2c, multiple procedures may be coded if “Multiple root operations with distinct objectives are performed on the same body part.” In the case of a vertebral tumor, the intent of the corpectomy is to remove a neoplastic tumor rather than prepping the space for fusion.
Q: Can we code Smith Peterson osteotomy separately with spinal deformity fusion?
A: Osteotomy procedures performed to realign the spine in spinal deformities (e.g., kyphosis, scoliosis) are coded separate from spinal fusions. These procedures will be discussed in detail in our PCS Spinal Fusions Advanced webinar on April 15, 2021.
Q: For the robotic assist code, what should the approach be if the instrumentation is placed through a small incision before the operative site is opened?
A: Read operative report documentation carefully when determining the approach character. In the case example in this webinar, the report suggests that all of the robotic work was performed before the operative site was exposed, which is a percutaneous approach. There may be cases where the robot is also used after the site has been opened, in which case, only assign one code for the open approach.
Q: How do you select the codes for neuromonitoring? In the 4A1 table, what is the Body System, Approach, and Function?
A: This will vary from procedure to procedure depending on the type of monitoring. The Function is “Electrical Activity” and the Qualifier is “Intraoperative” to show that neuromonitoring was done during the procedure. The body system is either Central or Peripheral Nervous system, depending on the documentation. The approach can also differ based on the method. In the cases we presented during this webinar, some contained enough information to assign a code for neuromonitoring and some did not. Again, you will need to know whether it was the central or peripheral nervous system that was monitored and the approach.
Q: Why isn’t a code for the bone graft assigned in the ACDF procedure?
A: The anterior cervical fusion code involved the use of an interbody fusion device, which also utilizes bone graft. According to the device hierarchy guideline B3.10c, if an interbody fusion device is used with bone graft, only the device for interbody fusion device is assigned. This was presented in the PCS Spinal Fusion Basics webinar last month.
Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-Approved ICD-10-CM/PCS Trainer
Senior Consultant
Kristi also performs DRG and APC audits and is known for her vast knowledge on coding vascular interventional radiology procedures. Kristi has an extensive background in coding education and consulting and is a national speakers on topics related to ICD-10 and CPT coding as well as code-based reimbursement.