# Implants included in Sacroiliac fusion?



## TammyVan (Apr 16, 2012)

My Spine folks have been perfoming sacroiliac joint fusions with documentation that mentions ‘implants'. I've been contemplating billing for the ‘implants', however my common sense says NO….we don't bill for instrumentation when doing a hip fusion, for example.
Documentation example:
This incision was taken through skin and subcutaneous tissues down to the level of the fascia, at which point, the navigated cannula was then brought into place. This was then punctured through the fascia down to the level of the iliac bone. Once down on the iliac bone, the navigation system was used to find ideal trajectories and pathways for the fusion devices across the sacroiliac joint. Once the ideal trajectories were selected, three Steinmann pin-type wires were placed across the sacroiliac joints in safe trajectories and safe pathways for the sacroiliac bone. Once across the sacroiliac joint, the pins were then drilled over with a cannulated drill, taking great care to hold the pins to make sure that they did not penetrate deeper. This was then followed by broaching, followed then by placement of implants. The broaching device significantly opened up the space and roughened up the joint surfaces of the sacroiliac joint as it passed across the joint, allowing for trans-joint fusion. In any case, once this was completed, the implants were placed across the sacroiliac joint. These were placed without significant difficulty over the guidewires, and once they were in place, they were checked using fluoroscopy and O-arm imaging to verify that their alignment and positions. They were all found to be in very good alignment and position, and because of this, the procedure was deemed complete.

Does 27280 include the implants?


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## maryc@trgltd.com (Apr 23, 2012)

*AMA - RUC response re 27280*

We had the same questions several months ago and contacted Dr. Bill Mitchell, the NASS Medical Advisor to the AMA's CPT Editorial Panel.  Dr. Mitchell advised that 27280 is to be reported for open procedures where there is a bone graft -- these procedures are primarily performed by the Trauma Surgeons now and not the patients who are presenting to spine surgeons with low back pain, SI joint dysfunction, or Sacroiliitis. 

Dr. Mitchell advised that NASS had created and submitted a new code application to assign the new percutaneous SI joint fusion procedures (Globus' Diana, Zyga, and SI-Bone) to a ****T code, which will become effective 1/1/13.  In the interim, these new procedures should be reported under an unlisted code (22899).  

If the open procedure is performed as a result of trauma/injury, then the graft and implants are already included and weighted as part of the RVU process in CPT 27280.  This was also confirmed  through AMA CPT Editorial Panel and the Relative Value Update Committee (RUC).  The fluoroscopy, however, may be reported separately through the end of 2012.    As of 1/1/13, the fluoro will be bundled into 27280.

I hope you find this information helpful.


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## TammyVan (Apr 25, 2012)

This information is much appreciated!


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## mmorningstarcpc (Apr 25, 2012)

Dr Mitchel is wonderful!!  Thanks for posting!!


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## maryc@trgltd.com (Apr 26, 2012)

*UPDATE on 27280 & 22899*

All:

Please note that I had an update from Allison Waxler on 4/24/12 that advised that "We do not have a definitive timeline for this project".  So the date I had provided of 1/1/13 is NOT accurate.  This can be verified as it is not yet on the AGENDA for the May meeting.  This means that a prospective T code will not go into effect until 7/1/13 at the earliest.

Thank you,
Mary Corkins


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## kdsampson (Jul 26, 2012)

*fluoroscopy code?*

I have an SI fusion for sacroilitis, so according to this thread I'll use 22899 for the fusion, but what code would the fluoro be? Would it also be unlisted?

Thanks!


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## maryc@trgltd.com (Aug 22, 2012)

*Fluoro billed separately*

Sorry for the delay -- you probably already have taken care of this....however, I thought I would reply.

According to NASS Reimbursement & Coding Committee Member, Dr. Kaufman, at the Park City Coding Update meeting in February 2012, for SI fusion, reported via one of the newer methodologies (ie. 22899) has not yet "bundled" the fluoro.  He advised that change this would likely occur in 2013 and not pay separately.  BUT, in 2012, the fluoro is still independently payable!

Make sure you report it sepately!

Mary Corkins
TRG


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## moort3 (Oct 10, 2012)

our physcian performs the SI fusion as an open procedure for sacroilitis  should we bill 27280?  Can we also bill for the implant as an unlisted code?

Thanks for any advice


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## maryc@trgltd.com (Oct 30, 2012)

*Update - 27280*

Hello Moort3, and anyone else working in the sacroilliac space!

First,a short answer for Moort3 -- the 27280 code already includes the implant.  From the SI-Bone guides, they provide EITHER 27280 or22899, PLUS Fluoro under 77003.  I agree.

Second, according to the publicly posted agenda, the AMA CPT Editorial Panel reviewed coding options for the various minimally invasive procedures that are currently being used for SI joint fusion or stabilization during their Oct 11-13 meeting.  Remember there are several companies with products/implants that are indicated for fusion of the SI joint.  The panel hasn't published their decision on coding for the various procedures yet -- and they are all very different! ...as well as different stages of development.  Stay tuned to the AMA website for more detail as this info is finalized.

In the interim, I strongly urge offices to pre-authorize the surgery and to include the full patient chart and a letter of medical necessity.  The Payors will need to see a confirmatory SI Joint injection as the source of pain, as well as any patient comorbid conditions which would limit patient treatment options, and then finally some commentary on the patient's Quality of Life (QoLY).  Some offices are now adding the Oswestry Disability Index (ODI) to address the QoLY issues to ALL patient charts where "low back pain" is the primary complaint.  Again, I think that this is a GREAT idea!

Like most new healthcare technologies, some of the manufacturers in this space also offer free assistance in the "pre-auth" area, so make sure to check with the rep!

Thank you, and I hope you all find this helpful!!!

Mary


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