A 52-year-old female, who is diagnosed with adult thoracolumbar scoliosis, underwent a staged anterior thoracolumbar fusion of T12-S1 one day ago. The patient is now being returned to the operative suite for stage II of the procedure which involves bilateral iliac fixation and posterior instrumented T10-S1 fusion with the VIPER® 2 System and bone graft. At surgery, screws were placed and recessed inside the iliac crest where bone had been excised for use as bone graft. Next, pedicle screws were inserted from T10-S1 followed by preparation of titanium rods preloaded with iliac connectors. The titanium rods with iliac connector were placed into the iliac screw. Derotation was performed from T12 down to S1 achieving spinal alignment. Finally, bone graft was placed in the posterior-lateral gutter for the posterolateral fusion. Is it appropriate to assign a separate code for bilateral iliac fixation performed with spinal fusion?
The placement of anchoring rods to the iliac wing should be coded separately in addition to the primary corrective surgeries of fusion and reposition. Spinal fusion to the sacrum in which screws are placed in the iliac wing are different from fusions that do not cross the S1 joint. Iliac fixation provides added structural support to the S1 fixation in long-segment spinal fusion. Assign the following ICD-10-PCS codes for the bilateral iliac fixation:
|0QH204Z||Insertion of internal fixation device into right pelvic bone, open approach|
|0QH304Z||Insertion of internal fixation device into left pelvic bone, open approach|