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Mastering SI Joint Fusion Coding: CPT 27278 & 27279

By Paul Cadorette, CPC, COC, CPC-P, COSC, CASCC, Director of Education, nimble solutions
Learn the 5 steps to arthrodesis coding in the Spinal Arthrodesis – Cervical and Lumbar Regions coding course, Tuesday, May 21 from 1-2pm Central. Register here.

This month’s ASC coding course puts the spotlight on Percutaneous SI Joint Fusion CPT codes 27278 and 27279 as well as the coding practices associated with spinal arthrodesis procedures.  

From what to look for in an operative report to understanding the latest CPT Assistant and CCI Edit Policy Manual guidelines, ASC coders will fine tune their skillset, remain compliant with diverse carrier coding policies, and earn CEU credits from AAPC by participating in this course.

Here’s a sneak peek into what you can expect for Percutaneous SI Joint Fusion best practices.

Coding for SI Joint Fusion

As part of our educational coding series, we’ll delve into the intricacies of Percutaneous SI Joint Fusion, shedding light on the nuances of CPT coding in this domain.  

The definition of “intra-articular” plays a pivotal role in understanding CPT codes related to SI joint fusion procedures. While the term signifies being within the joint, it’s crucial to differentiate between procedures that involve transfixing the joint and those that do not. 

  • Code 27278: This code is designated for the percutaneous placement of an intra-articular stabilization device into the sacroiliac joint using a minimally invasive technique that does not transfix the joint. 
  • Code 27279: In contrast, this code is reserved for procedures involving transfixing the joint, wherein internal fixation devices pass through the ilium, across the sacroiliac joint, and into the sacrum. 

To be clear, transfixing is placement of a fixation device(s) (normally a screw[s]) utilizing a lateral approach from the outer cortex of ilium, all the way through the ilium until it passes across the sacroiliac joint and comes to rest within the sacrum.  This would be reported with CPT code 27279. 

 A device that is inserted from a posterior approach directly into the sacroiliac joint (intra-articular) is reported with CPT code 27278 regardless of wings or posts that may engage the sacrum and ilium securing the intra-articular implant in place.  While there may be other interpretations of what transfixing means, this does not represent a transfixing technique as defined by CPT manual guidelines when the device is placed directly into the SI joint.  

SI Joint Fusion: Hybrid Devices and Compliance

The insertion of hybrid devices, combining intra-articular and transfixing techniques, presents a coding challenge.  

While some suggest reporting both 27278 and 27279, it’s essential to exercise caution due to the lack of official endorsement. For example, NASS (North American Spine Society) recommends use of the unlisted spine code 22899 and Cigna Policy #0303 has listed the hybrid technique as experimental/investigational.  

Carrier policies and industry guidelines, such as those from NASS and Cigna, underscore the importance of coding compliance and confirming codes with your individual carrier policies.   

If you should decide to report both codes, keep in mind that there is now a CCI edit which bundles 27278 into 27279 for any claims you submit in which the carrier is following NCCI edit guidelines.

Master SI Joint Fusion Coding, Arthrodesis Coding

Mastering arthrodesis coding requires a comprehensive understanding of operative reports, procedure terminology, and coding guidelines.  Our upcoming ASC coding course offers a unique opportunity to enhance your skills, ensuring accuracy, compliance, and optimal reimbursement.  

Join me on May 21st, from 1-2pm Central, as we unravel the intricacies of spinal arthrodesis coding and empower you to excel in your coding endeavors.  

Click here to register for the Spinal Arthrodesis – Cervical and Lumbar Regions coding course.