During a Posterior Lumbar Interbody Fusion (PLIF) of L4-L5, the surgeon also placed autograft and allograft in the “gutters”. Where are the “gutters” located on the spine and is there a corresponding PCS code for this procedure?
The term “gutter” is referring to the Transverse Process of the spine, which is part of the posterior column. Therefore, bone graft placed in the gutter(s) of L4-L5 is assigned a PCS code for Posterior Lumbar Fusion with a Qualifier of ‘1’ for Posterior Approach, Posterior Column.
It is common for both a PLIF and a Posterior Lumbar Fusion to be performed together. In addition, we have Spinal Fusion Guidelines specifying that both types of fusions should be reported when performed together:
- PCS Guideline B3.10b: A separate procedure code is assigned for each vertebral joint that uses a different device and/or qualifier.
For this scenario, the following fusion codes would be assigned:
- Fusion of Lumbar Vertebral Joint with Interbody Fusion Device, Posterior Approach, Anterior Column, Open Approach (0SG00AJ)
- Fusion Lumbar Vertebral Joint with Autologous Tissue Substitute, Posterior Approach, Posterior Column, Open Approach (0SG0071)
- ICD-10-PCS Coding of Complicated Spinal Fusions: Qualifier J, Posterior Approach to Anterior Column, Lynn Kuehn, RHIA, CCS-P, FAHIMA
- 2018 Coding Handbook, Spinal Fusion and Refusion
- ICD-10-PCS Coding Guidelines for Fusion Procedures of the Spine