Article Highlights

  • Use of qualifier J in ICD-10-PCS when coding spinal fusions is challenging
  • Determining the approach for spinal procedures can be complicated; it may not be direct
  • Be sure to distinguish between posterior lumbar interbody fusion (PLIF) and Posterior Lumbar Fusion. They are not the same.

Use of qualifier J is the biggest challenge I’ve found when teaching spinal fusions. At first glance, it just doesn’t seem to make sense. How can you come from the posterior (back side) of the patient and end up on the anterior (front side) of the spinal column when the spinal cord is in the way?

The simple explanation is that no one said the surgeon had to go straight from back to front. The surgeon takes a route that goes around the side of the vertebra and approaches the front side of the spinal column from the side, not directly from the front.

Still not making much sense? Let’s look at the drawing.

In a posterior lumbar interbody fusion, the disc is accessed from a posterior incision but the surgeon clears away enough bone and other tissue to work their way to the lateral part of the front. Disc is cleared away and the interbody fusion device is placed between the bodies (anterior column) from the side. If two cages are required, the same process is repeated by going around the opposite side of the spinal column, putting the interbody fusion device between the bodies from the other side. This procedure is called a posterior lumbar interbody fusion, or PLIF for short.

Let’s clarify one other item. A PLIF procedure is not the same as a Posterior Lumbar Fusion. The Posterior Lumbar Fusion is Qualifier 1, Posterior Approach to Posterior Column and is performed looking directly at the back of the spine, as pictured in the Posterior View of our drawing. This posterior fusion is performed using bone grafts and there is no abbreviation for this posterior fusion. It is common for the surgeon to perform both of these at the same operative session, fusing the anterior column and the posterior column, both through the posterior approach.

Each of these procedures would be coded separately. If performed at one lumbar joint using a cage on the anterior and autologous bone on the posterior, the codes would be 0SG00AJ and 0SG0071.

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