Spinal Fusion Coding: Identifying the Column Being Fused

When coding a spinal fusion record, the operative report should be reviewed to determine if the fusion is being performed on the anterior or the posterior column of the spine, or even both. 

Anterior Column

The anterior part of the spinal column refers to the side of the spine that faces the front of the body. If the fusion being coded is described as interbody or has documentation of insertion of an interbody fusion device/cage that means that the anterior side of the spinal column is where the fusion is taking place. Anterior column is not the same as anterior approach.

Posterior Column

The posterior part of the spinal column refers to the side of the spine that faces the back of the body. This is the side you can feel if you run your fingers over someone’s back. If the operative note describes insertion of bone graft along with rods and screws or decortication of the spinous processes this is in the posterior column. Other terms that indicate work on the posterior column are lamina, facet, articular process and transverse process.

Photo courtesy: https://commons.wikimedia.org/wiki/File:722_Feature_Osteoprosis_of_Spine.jpg 

Both Columns?

Some patients have fusion of both sides of the spinal column. This is sometimes referred to as a 360degree fusion and may or may not require turning the patient, depending on the technique being used. ICD-10-PCS has different qualifier values for reporting anterior and posterior fusions, so if both sides of the spinal column are fused, separate codes will be needed to report each type of fusion (see ICD-10PCS coding guideline B3.10b)

Coding Tip: Review documentation in the operative note carefully to identify if only one or both sides of the spinal column are fused as reporting both anterior and posterior fusion together results in a higher weighted DRG. 

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