Cracking the Code

Combined Anterior and Posterior Spinal Fusion

Sometimes, inpatient coders will come across lumbar spinal fusion procedures that involve both anterior and posterior approaches. Typically, there is an incision in the front of the body through the abdomen (anterior) and then another incision in the lumbar or lower back region (posterior). Be sure to thoroughly review the operative report to ensure all ICD-10-PCS codes are captured.

Q: A woman is admitted to the hospital with lumbar spondylolisthesis and lumbar spinal stenosis. The surgeon performs a lumbar laminectomy. He used up ankle curettes to release the dura from its attachment to the medial facet capsule. Foraminotomies were then performed. From a left-sided approach, the surgeon placed a Trelloss transforaminal lumbar interbody fusion spacer. Pars interarticularis on the left side was resected along with the superior aspect of the L3-4 and L4-L5 facets. Trelloss banana-shaped titanium cages were then placed into the disc space and tapped as anterior as possible toward the anterior part of the disc space. Behind the cages morselized local autograft bone was then packed into the disc space. A Trocar was advanced into the iliac crest on the right side. Bone marrow was harvested and iliac crest bone marrow was mixed with the morselized local autograft bone and was laid over the decorticated posterolateral gutters for purposes of arthrodesis from L3-L5 bilaterally.
A: 0SG10AJ, fusion of 2 or more lumbar vertebral joints with interbody fusion device, posterior approach, anterior column, open approach; 0SG1071, fusion of 2 or more lumbar vertebral joints with autologous tissue substitute, posterior approach, posterior column, open approach; 01NB0ZZ, release lumbar nerve, open approach; 0SB20ZZ, excision of lumbar vertebral disc, open approach; 07DR3ZZ, extraction of iliac bone marrow, percutaneous approach
Reference: ICD-10-PCS Coding Guideline B3.10b, Coding Clinic 4th Quarter 2010 pgs. 125-129: Spinal fusion and refusion, and Coding Clinic 3rd Quarter 2013 pgs. 25-26: 360-degree spinal fusion.
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