Spinal fusions can be performed using a variety of techniques, and selection of the correct sixth character is crucial in identifying the device/material used to perform the fusion. Understanding the different methods of spinal fusions and associated devices, along with Official Coding Guidelines and Coding Clinic, can help to alleviate spinal fusion confusion.

ICD-10-PCS Character 6: Device

ICD-10-PCS defines Fusion as joining together portions of an articular body part, rendering the articular body part immobile. The body part is joined together by fixation device, bone graft, or other means. For spinal fusions, the Device identifies the material used to accomplish the fusion.

• Tip: materials such as sutures, ligatures, radiological markers, and postoperative wound drains are considered integral to the performance of a procedure and are not coded as devices (OCG B6.1b)

• Tip: Rods, plates, and/or screws that are used in conjunction with a spinal fusion procedure are included in the fusion and are not separately coded (CC 3^rd Qtr. 2014, Page: 30)

Device/Material Types

• Autologous Tissue Substitute (7)- bone graft obtained from the patient during the procedure. Bone grafts may be harvested locally using the same incision, or from another part of the body requiring a separate incision.

• Tip: If autologous bone harvesting is performed through a separate incision (i.e., iliac crest) a separate procedure code is required. If autologous bone is harvested locally from the vertebral site, then it is not coded separately (OCG B3.2)

• Nonautologous Tissue Substitute (K)- bone is harvested by a tissue bank from a cadaver
• Interbody fusion devices (A)- interbody fusion cages, interbody spacers, BAK cages, PEEK cages, bone dowels, etc.
• Synthetic Substitute (J)- demineralized bone matrix, bone morphogenic proteins (BMP), synthetic bone graft extenders, etc.

• Tip: Code a separate procedure for each vertebral joint that uses a different device and/or qualifier (OCG B3.10b).

Device Hierarchy (OCG B3.10c)

Combinations of devices and materials are often used on a vertebral joint during a spinal fusion. When combinations of devices are used on the same vertebral joint, the device value coded for the procedure is as follows:

• If an interbody fusion device is used to render the joint immobile (containing bone graft or bone graft substitute), the procedure is coded with the device value Interbody Fusion Device (A)
• If bone graft is the only device used to render the joint immobile, the procedure is coded with the device value Nonautologous Tissue Substitute (K) or Autologous Tissue Substitute (7)
• If a mixture of autologous and nonautologous bone graft (with or without biological or synthetic extenders of binders) is used to render the joint immobile, the procedure is coded with the device value Autologous Tissue Substitute (7)

Interbody Fusion Devices (A)

An interbody spinal fusion device is placed into the disc space after removal of (or portions of) the disc and vertebral bone. Interbody fusion devices can be made of metal or plastic and are packed with bone (or bone-like material), which is placed in or around the implant. Interbody fusion devices also include devices such as cortical bone dowels or intervertebral body spacers that are composed completely of bone (CC 3^rd Qtr. 2019 Pages: 35-36).  

• Tip: An interbody fusion is a fusion of the anterior column of the spine (CC 2^nd Qtr. 2009 Pages: 3-4).

New Technology: Porous and Radiolucent Interbody Fusion Devices (F)

The COHERE® and COALESCE® interbody fusion devices are examples of radiolucent porous interbody fusion devices. The porous material promotes bone ingrowth to enhance the fusion (CC 4^th Qtr. 2017 Pages: 76-77). In 2017, a new device value was added to code table XRG, Joints, Fusion, to capture the use of radiolucent porous interbody fusion devices during spinal fusions.

Spinal Fusion Device Reference Table

• Tip: Refer to the table below for assistance in selecting the correct device value code for spinal fusions.

Additional Information

For more information on coding, auditing, and cancer registry, check out the MRA website here. 

Additional information regarding ICD-10-PCS 6^th character Device in spinal fusions can be found below:

• ICD-10-PCS Official Guidelines for Coding and Reporting 2022, B6.1b
• ICD-10-PCS Official Guidelines for Coding and Reporting 2022, B3.2
• ICD-10-PCS Official Guidelines for Coding and Reporting 2022, B3.10b
• ICD-10-PCS Official Guidelines for Coding and Reporting 2022, B3.10c
• AHA Coding Clinic, Third Quarter 2014, Page: 30
• AHA Coding Clinic, Third Quarter 2019, Pages: 35-36
• AHA Coding Clinic, Second Quarter 2009, Pages: 3-4
• AHA Coding Clinic, Fourth Quarter 2017, Pages: 76-77
• Cervical Spondylosis and Spondylotic Cervical Myelopathy, Merk Manual: Professional Version https://www.msdmanuals.com/professional/neurologic-disorders/spinal-cord-disorders/cervical-spondylosis-and-spondylotic-cervical-myelopathy
• Spinal Fusion, Mayo Clinic https://www.mayoclinic.org/tests-procedures/spinal-fusion/about/pac-20384523