Spinal fusion surgery is on the rise. From 2001 to 2011, the number of spinal fusions in the United States increased 70 percent. These procedures have become even more common than hip replacements. More than 465,000 spinal fusions were performed in the United States during 2011.

With the overall increase of these procedures, it is important that providers carefully review the documentation prior to submitting the claim. To ensure proper coding, providers must determine the following:

• Is it a fusion or refusion procedure?
• What is the correct operative approach: anterior, posterior, or combined?

For example, a combined anterior posterior procedure will have two incisions. This must be documented separately. Often, there are two different surgeons involved as well. Documentation on the operative report should reflect that the patient was turned over (from his or her back to stomach, or vice versa) between the two procedures.

In the near future, our Corporate and Financial Investigations Department will be taking a closer look at the coding for these procedures to ensure that the claims are paying to the correct diagnosis related group (DRG).

Learn more

The following organizations offer additional information on current coding guidelines for spinal fusion:

• American Hospital Association (AHA). Visit the AHA website and click on Coding Clinic on the top tool bar.
• Centers for Disease Control and Prevention (CDC). Download the ICD-10-CM Official Guidelines for Coding and Reporting at the CDC website.