AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2023 Issue 2; Ask the Editor

Spinal Fusion Using Allograft Bone Graft and Bone Marrow Aspirate

A patient with lumbar stenosis with neurogenic claudication undergoes a second stage posterolateral spinal fusion from L2-L4. Through a Jamshidi™ needle, the surgeon obtained bone marrow aspirate from the iliac crest. Soft tissues were removed from the facet joints, transverse processes, and pars at L2-L3. A high-speed burr was used to decorticate the facet joints, transverse processes, and pars in preparation for fusion. Allograft bone combined with the bone marrow aspirate was then impacted into the fusion site. The same procedure was then performed on an additional level. PCS Guideline B3.10c states that if a mixture of autologous and nonautologous bone graft (with or without biological or synthetic extenders or binders) is used to render the joint immobile, the device value Autologous Tissue Substitute is assigned. However, we are unsure whether bone marrow aspirate is classified as a graft. What is the appropriate code and device value for the posterior fusion with a combination of allograft and bone marrow aspirate? ...

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