Neurosurgery Coding Alert

Find out what your physician needs to include for complete documentation.

You have reason to rejoice if your neurosurgeon performs minimally invasive sacroiliac joint fusions, because CPT® 2015 adds a regular Category I code to replace the Category III code you’ve been using — which could mean easier reimbursement. Plus, check out the revision to 27280. 

Shift 0334T to 27279 Starting January 1

Since July 2013, you should have been reporting minimally invasive sacroiliac joint fusion with a Category III CPT® code, 0334T (Sacroiliac joint stabilization for arthrodesis, percutaneous or minimally invasive [indirect visualization], includes obtaining and applying autograft or allograft [structural or morselized], when performed, includes image guidance when performed [e.g., CT or fluoroscopic]). 

When your surgeon does bilateral fusions, you should have been listing CPT® code 0334T on two line items with the RT (Right side) and LT (Left side) modifiers on each line item to indicate the bilateral fusion.

Effective January 1, 2015, new code will be implemented to describe reporting percutaneous/minimally invasive sacroiliac joint arthrodesis. The new code is: 

 27279 — Arthrodesis, sacroiliac joint, percutaneous or minimally invasive (indirect visualization), with image guidance, includes obtaining bone graft when performed, and placement of transfixing device

Why This Change? 

This isn’t a change without a rationale. Professional societies have supported minimally-invasive techniques. Also, note that there is some published data to support the safety and efficacy of this procedure, which is important to payers.  “Nonetheless, US and European prospective multicenter trials comparing minimally-invasive SI fusion with non-operative treatment are ongoing,” says Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center, Edison.

 The International Society for the Advancement of Spine Surgery (ISASS) supports this change as the new code (27279) reflects the acceptance and implementation of new procedures by physicians. According to the ISASS, minimally invasive surgical (MIS) approach has emerged as the standard of care for sacroiliac joint fusion over the last four years. The ISASS and Society for Minimally Invasive Spine Surgery (SMISS) have recently published the results of a member survey examining the preferences in surgeon practice of MIS sacroiliac fusion. According to this survey, MIS is a preferred approach to open techniques for sacroiliac joint fusion. 

Read more about this survey at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3924210/

What do experts say: Experts have shared appreciation for the code. “I do appreciate that the code is more specific and will include the device,” says Lisa Fisher Blackmon, CPC, Surgical Coder, Integrated MD Solutions, Inc., Daphne, AL. The new code should not be difficult for practices to implement. “There will not be that much of a transition into using this new code,” says Blackmon. “The previous CPT® code for arthrodesis of the sacroiliac joint encompassed a number of different methods and approaches however this new code will allow providers to be paid for the procedure in specific.”

“As with other transitions from Category III to Category I codes, once there is FDA approval, US publications describing safety, and performance of the service across multiple sites, the CPT® Editorial Panel will typically support development of a Category I code to replace the tracking Category III code,” Przybylski says. “While this change does not guarantee payment by third-party payers, it does show that the clinical use is becoming more widespread.  However, the level of published evidence required by third-party payers to cover new technology is much higher than that required by the CPT® Editorial Panel to approve a Category I code.”

Keep Complete Documentation

Make sure you have complete documentation for patients undergoing sacroiliac joint fusion: 

• Complete history and physical examination supporting the likely existence of SI joint pain
• Fluoroscopically guided sacroiliac joint block on the affected side with at least a 75% reduction in pain
• Conservative treatment which includes non-steroidal anti-inflammatory drugs and/or opioids and one of the following: (1) an adequate period of rest, (2) an adequate course of physical therapy, failing to provide relief in pain (3) Inadequate response to sacroiliac joint steroid injections or (4) inadequate response to radiofrequency ablation of the affected joint. 
• Persistence of sacroiliac pain for a minimum of six months
• Other possible conditions for patient’s pain have been ruled out
• Surgeon’s opinion that sacroiliac joint fusion is the only option for long-term pain relief.

Don’t Miss This 27280 Revision

Another change you will see in 2015 is the revision in the sacroiliac joint arthrodesis code 27280. The revisions in the code descriptor are marked below:

• 27280 — Arthrodesis, open, sacroiliac joint (, including obtaining bone graft), including instrumentation, when performed

Note: You will find no changes in the sacroiliac joint implant removal and revision. You report revision and/or removal of the sacroiliac joint implant using 22899 (Unlisted procedure, spine) or 27299 (Unlisted procedure, pelvis or hip joint) depending on the type of approach and procedure your surgeon performed.