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Coding Spinal Fusions

Published on 

Wednesday, August 18, 2021

 | Coding 
 | FAQ 
Did You Know?

It is common for a surgeon to perform a fusion on the anterior column and the posterior column of the spine through a single incision.

Why It Matters

The codes for anterior and posterior spinal column fusion will group to the higher-weighted DRG group (453-455). You could be under-coding and losing out on thousands of dollars of reimbursement for your facility.

What Can I Do?

First, make sure you are familiar with the anatomy and the terms describing the anterior and posterior columns.

The anterior column consists of:

  • Anterior longitudinal ligament
  • Vertebral body
  • Intervertebral Disc
  • Annulus Fibrosus
  • Posterior Longitudinal Ligament

The posterior column consists of:

  • Pedicles
  • Transverse Process (gutter)
  • Lamina
  • Facets
  • Spinous Process

The anterior column fusion is usually what is described first in the Operative Report and is often coded correctly. However, the posterior fusion is typically overlooked and not reported. One of the reasons may be the unfamiliarity with the terms describing the posterior column. For example, a surgeon may document that bone graft was placed in the “gutters”. Gutters is another term to describe the Transverse Process, so bone graft placed in the gutters is a posterior spinal fusion.

Based on the above information, there should be a code for fusion of the anterior column and a code for the posterior column in order for the claim to group to the appropriate higher-weighted DRG.

Article Author: Anita Meyers, RHIT, CCS
Anita Meyers, RHIT, CCS, is an Inpatient Coding Professional at Medical Management Plus. Anita has over twenty-six years of experience in inpatient and outpatient coding including 17 years of work at AQAF reviewing inpatient and outpatient records from Alabama hospitals. In addition to reviewing records she was the team leader in Beneficiary Services where she participated in case review activities, received and processed beneficiary complaints and handled fee-for-service denials for home health, hospice and skilled nursing facility services. Prior to joining the MMP team, Anita left AQAF to become an inpatient contract coder and worked at various hospitals in central Alabama. In her current position, Anita is an integral part of the Inpatient Services at Medical Management Plus.

This material was compiled to share information.  MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.