Spinal Fusion vs. Spinal Stabilization
The First Q 2018 (P. 22) Coding Clinic provided clarification that stated spinal fusion procedures without bone graft cannot be coded to the root operation “Fusion”. The rationale for this advice is that while the root operation of “fusion” does not require the use of bone graft, the spinal fusion guideline indicates that a spinal fusion requires bone graft. This clarification was provided based on advice provided in the Second Q 2017 (P. 23) Coding Clinic for the following scenario:
The patient underwent laminectomy C3 through C7, decompression of the spinal cord, placement of posterior instrumentation and spinal fusion, due to cervical spondylosis. After decompression of the spinal cord, lateral mass screws were placed from C3 – C6 bilaterally with connecting rods. The following codes were recommended for this case:
0RH104Z Insertion of internal fixation device into cervical vertebral joint, open approach
00NQ0ZZ Release cervical spinal cord, open approach
Rationale:
The insertion of rods and screws is not the same as the placement of a pedicle based stabilization device. The device value “Spinal stabilization device, pedicle based” is not used, because that device value is only used for specific stabilization systems. The root operation “Release” is coded separately when decompression is documented, and there is a distinct surgical objective, not just incidental removal of the lamina to reach the site of the procedure.
Clinical Information:
Fusion surgery of the spine is accomplished by using a bone graft to stimulate bone to grow between two or more adjacent spinal segments to prevent future motion. Often metal instrumentation is used to stabilize the spinal segments while bone eventually forms between the vertebrae.
Dynamic stabilization is a surgical technique designed to allow for some movement of the spine while maintaining enough stability to prevent too much movement. Stabilization devices are designed to limit abnormal segmental motion, prevent nerve impingement, and may be used as an alternative to vertebral fusion procedures. Like the instrumentation used during spinal fusion surgery spinal stabilization devices are placed in the posterior column of the spine.
When coders encounter a “spinal fusion” case that does not indicate a bone graft is used a careful review of the operative note is required to determine what the correct device character should be:
4 Internal Fixation Device or B Spinal Stabilization Device, Interspinous Process or C Spinal Stabilization Device, Pedicle-Based or D Spinal Stabilization Device, Facet Replacement
Correct selection of the device character is not only imperative for data quality but also the correct DRG assignment. Consider the following scenario:
| Internal Fixation Device | Spinal Stabilization Device | |
| PDX | M47.22 | M47.22 |
| Procedure | 0RH104Z | 0RH10(B,C,D)Z |
| DRG | 517 | 518 |
| Relative Weight | 1.4361 | 2.893 |
The table below identifies the manufacturer name for some of the different types of spinal stabilization devices and can assist you in assigning the correct device character. You may also choose to speak with your providers and/or material management to see if spinal stabilization devices are being utilized and if so, which manufacturer.
| ICD-10-PCS Value | Description | Manufacturer Trade Names |
| Spinal Stabilization Device, Facet Replacement | Intended to replace the natural facets and other posterior elements of the spine, restoring normal (or near-normal) motion while providing stabilization of spinal segments. | Total Facet Arthroplasty System Total Posterior System |
| Spinal Stabilization Device, Interspinous Process | The interspinous process devices are designed to distract (open) the foramen, where the nerve endings pass away from the center of the spinal region and limit spinal extension (the position the spine takes on when bending backward). | X-STOP(R) Spacer Wallis System Diam Corflex |
| Spinal Stabilization Device, Pedicle-Based | Pedicle-based dynamic devices were first designed to stabilize the abnormal segment and to unload degenerated discs and facet joints, while maintaining the same level of normal motion. By unloading the pressure on the degenerated disc and facets, pedicle-based dynamic devices have the potential to reduce pain associated with these anatomical structures. |