Knowledge Base Article

Q:

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?

A:

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)

Resources:

• 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