ISASS and Coding Community Lend Support for Lateral MIS Procedures | SI-BONE
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ISASS and Coding Community Lend Support for Lateral MIS Procedures

In the December 2020 issue of International Journal of Spine Surgery (www.ijssurgery.com), two important articles focus on MIS SI joint fusion with associated recommendations and evidence-based guidelines for payor criteria and physician coding from the International Society for the Advancement of Spine Surgery (ISASS):

  • Editorial on SI joint fusion procedures and associated CPT coding
  • Update to the ISASS Policy Statement on MIS Sacroiliac Joint Fusion

The publications reviewed all available literature and evidence for current SI joint fusion procedure types, as well as reviewed existing CPT coding used to describe them. The articles confirm that the available evidence for lateral transiliac MIS SI joint fusion (i.e., iFuse) is sufficient to determine medical necessity and ISASS recommendations for adoption and coverage; but that evidence for posterior (dorsal) MIS SI joint fusion (whether using bone allograft products or 510k-cleared medical devices) is lacking, and not recommended at this time.

ISASS’ findings confirm what many coding experts have already identified as the appropriate CPT codes to report various types of MIS SI joint fusion. Most recently, coders point out in the October issue of AAPC Healthcare Business Monthly that while 27279 describes laterally placed implants such as iFuse, and has appropriate Work RVUs, the MIS posterior (dorsal) SI joint fusion procedure should be reported using an Unlisted CPT code (22899 [unlisted procedure, spine] or 27299 [unlisted procedure, pelvis or hip joint]), since neither 27279 nor 27280 CPT codes describe them.

Editorial

SI Joint Fusion Procedures and CPT Coding

Editor' Introduction: Update on Current Sacroiliac Joint Fusion Procedures: Implications for Appropriate Current Procedural Terminology Medical Coding

Lorio M. Int J Spine Surg. 2020 Dec;7136. DOI: 10.14444/7136

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Policy Statement

ISASS 2020 Policy Update on MIS SI Joint Fusion

International Society for the Advancement of Spine Surgery Policy 2020 Update—Minimally Invasive Surgical Sacroiliac Joint Fusion (for Chronic Sacroiliac Joint Pain): Coverage Indications, Limitations, and Medical Necessity

Lorio M, Kube R, Araghi A. Int J Spine Surg. 2020 Dec;7156. DOI: 10.14444/7156.

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Insurance Support
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Insurance Support

Will Your Insurance Cover iFuse?

This is a common question for patients and providers alike. Minimally invasive surgical fusion of the SI joint is not universally covered by insurance companies.

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