AHA Coding Clinic® for HCPCS - 2016 Issue 3; ASK THE EDITOR

Sacroiliac joint fusion

A patient underwent a minimally invasive sacroiliac (SI) joint fusion for severe pain caused by insufficiency fractures of the sacrum. The procedure itself reads exactly like CPT code 27279, Arthrodesis, sacroiliac joint, percutaneous or minimally invasive (indirect visualization), with image guidance, includes obtaining bone graft when performed, and placement of transfixing device. But according to the instructional notes under CPT codes 27216 and 27280, CPT code 27279 is for percutaneous/minimally invasive SI joint arthrodesis when there is no fracture or dislocation. If the patient has a fracture or dislocation, it would be coded to CPT code 27216, Percutaneous skeletal fixation of posterior pelvic bone fracture and/or dislocation, for fracture patterns that disrupt the pelvic ring, unilateral (includes ipsilateral ilium, sacroiliac joint and/or sacrum), assuming that the fracture disrupts the pelvic ring. According to CPT Assistant, Sept. 2013, page 19, CPT code 27216 generally refers to repair of high impact fractures from trauma that result in pelvic instability, as opposed to insufficiency fractures, and require extensive repair. Can you clarify which CPT would be appropriate in this case, 27279 or 27216? ...

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