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: