by Lynn Kuehn, MS, RHIA, CCS-P, FAHIMA
Scoliosis treatment and spinal fusion coding can be challenging but it’s not as bad as it seems. We have several resources to use in assigning the correct codes in various situations. I received a question recently about a common scenario, which should help everyone feel more secure in this coding.
The case involved a patient who had MAGEC® rod placement from T3 to L3 but also had what the surgeon called a fusion from T3 to T4 using bone morphogenetic protein, or BMP. The question involved how many codes were actually required to describe this procedure. Let’s look at each part of this procedure separately.
The placement of the MAGEC® growing rods will require two codes in this case, because the rods will be treating scoliosis in both the thoracic spine and the lumbar spine from T3 to L3. This is coded as XNS4032 and XNS0032, for Reposition of the thoracic vertebrae and the lumbar vertebrae.
Now on to the fusion part of this question: Documentation stated that a fusion was performed using BMP. Based on guidance in Coding Clinic 2nd Quarter 2017 on page 23, we know that spinal fusion requires a bone graft. BMP assists bone growth but is not actually bone. Therefore, we’ll follow the guidance that says that Insertion is to be assigned when no bone graft is documented. Therefore, code 0RH604Z would be assigned for this Insertion. The BMP can also be coded as 3E0U0GB, if that is the facility policy, based on Coding Clinic 1st Quarter 2018 page 8.
To further support that both the MAGEC® Rod Placement and Fusion (in this case Insertion) are to be coded, the FY2020 PCS guidelines have a new guideline about this. Guideline E1.b on New Technology codes uses MAGEC® rods as an example and says that both procedures are coded.
When multiple procedures are performed, New Technology section X codes are coded following the multiple procedures guideline.
Examples: Dual filter cerebral embolic filtration used during transcatheter aortic valve replacement (TAVR), X2A5312 Cerebral Embolic Filtration, Dual Filter in Innominate Artery and Left Common Carotid Artery, Percutaneous Approach, New Technology Group 2, is coded for the cerebral embolic filtration, along with an ICD-10-PCS code for the TAVR procedure.
Magnetically controlled growth rod (MCGR) placed during a spinal fusion procedure, a code from table XNS, Reposition of the Bones is coded for the MCGR, along with an ICD-10-PCS code for the spinal fusion procedure.
To learn more about pediatric musculoskeletal procedures, click here.
ICD-10-PCS for Pediatrics Coding Suite
Comprehensive and complete guidance to ICD-10-PCS coding of procedures performed on pediatric patients. Lynn Kuehn, a nationally recognized expert in ICD-10-PCS coding, worked in conjunction with leading Children’s Hospitals to develop this program to address complex and unique pediatric procedures current performed by leading pediatric hospitals.