coding a spinal fusion

annnd2009@gmail.com

Hi,

May I start by saying "I hate spines". Feel free to correct or clarify any misconceptions.

1.Cervical fusions will take a cc
2.Anterior with posterior aproach (BOTH) any level will take cc (I think?)
3.Lumbar fusions -EITHER approach- will require an MCC

TODAY- the encoder showed me something that I want to see if I can make a general assumption about

4. IF SCOLIOSIS OR CURVATURE (make pdx)- is a diagnosis WITH A LUMBAR LEVEL FUSION- even if other spinal dx like spondylosis exist- THIS WILL TAKE A CC.

Do those assumptions- especially number 4 sound correct?

Thanks for any feedback or corrections!

Ann Donnelly,RN,BSN,CCDS
annnd2009@gmail.com

catladyrn

Hi Ann,

Rather than relying on an encoder, I would recommend you look at the overall DRGs to give you an idea of what diagnoses and what procedures fall where, and which ones can be upgraded with CCs and/or MCCs. The DRG Expert book has a list, or if you look at the spreadsheet I'm attaching (which can be downloaded from cms.gov and which I use every day), and scroll down to MDC 8, it's easy to see where anterior/posterior fusions go, or what the impact of scoliosis as a principal diagnosis would be. Hope that helps.

Renee

Linda Renee Brown, RN, MA, CCDS, CCS, CDIP

jolene.file

Hi Ann!

A little confused on your question. Are you asking what diagnoses will make a difference as far as cc or MCC? I think you would need to either run it through the grouper to know that answer or like was stated in an earlier reply reference the DRG Expert. The diagnoses are what drive the cc or MCC classification for the MS-DRG.

Hope that is helpful!

Jolene File,RHIT,CCS,CPC-H,CCDS
Documentation Improvement Specialist-Coder
Hays Medical Center
jolene.file@haysmed.com

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axel.olson@essentiahealth.org

Hi Ann...

I would make sure that the scoliosis/kyphosis/lordosis truly meet the criteria for PDX and that the operative report supports this.

Often the surgeons will discuss the instabalitiy in the surgical area and the need to stabalize/support it.
The fusion and the instrumentation do this.

But im not sure that everytime these curvatures are mentioned in the history that they are significant enough to meet criteria for PDX... still a gray area for me...

According to the DRG expert from OPTUM and via the codeset I have noticed a large difference if able to use DRG 456,457,and 458

Also... in the 2014 CDI Pocket Guide; they state
"...most patients who are hospitalized for (acute compression fracture of a vertebral body) are elderly or debilitated, frequently have severe osteoporosis, and did not experience signigicant trauma (even though they often have had a minor fall either recently or acutely.)
Under these circumstances the most accurate and speific diagnosis is usually not "traumatic" but rather pathologic (including non-traumatic, insufficiency, spontaneous, chronic) or osteoporotic vertebral fracture."

Using the above I would be inclined to query a surgeon for pathologic fracture of spine if a pt came in with a vertebral fracture after a "low-impact" fall and a hx of osteoporosis or osteopenia.

If code 733.13 (Pathologic fracture of vertebrae) is PDX then DRG 456,7,8 can be used.

Axel Olson, RN, CDS
Clinical Documentation Improvement
Essentia Health
Axel.Olson@essentiahealth.org