How To Use CPT Code 27279

CPT 27279 refers to the arthrodesis of the sacroiliac joint, a minimally invasive procedure performed under image guidance. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 27279.

1. What is CPT 27279?

CPT 27279 is a medical procedure code used to describe the arthrodesis of the sacroiliac joint, which is a minimally invasive surgery performed under image guidance. This procedure involves the surgical immobilization of the sacroiliac joint using fixation devices and may also include the use of a bone graft to promote artificial bone generation in the joint area.

2. 27279 CPT code description

The official description of CPT code 27279 is: “Arthrodesis, sacroiliac joint, percutaneous or minimally invasive (indirect visualization), with image guidance, includes obtaining bone graft when performed, and placement of transfixing device.”

3. Procedure

The 27279 procedure involves the following steps:

1. Preparation and anesthesia of the patient.
2. Incision in the skin over the ilioinguinal area (lower outer area of the abdomen).
3. Dissection through the subcutaneous tissue, preserving nerves and veins.
4. Detachment of abdominal muscles from the ilium to access the sacroiliac joint capsule.
5. Incision of the joint capsule to enter the joint.
6. Debridement of the sacroiliac joint cartilage using a burr.
7. Fusion of the sacroiliac joint using fixation devices such as K wire, staples, plates, or headless screws.
8. Potential use of a bone graft obtained from nearby bone to pack the joint being fused.
9. Performance of the procedure under image guidance.
10. Stopping bleeding at the surgical site and suturing the soft tissue in layers.
11. Placement of the joint in a pelvic cast for a period of about four to six weeks.

4. Qualifying circumstances

Patients eligible to receive CPT code 27279 services are those who have been diagnosed with sacroiliac joint dysfunction or instability, causing significant pain and affecting their daily activities. This procedure is typically recommended for patients who have not responded to conservative treatments such as physical therapy, medications, or injections. A thorough evaluation of the patient’s medical history, physical examination, and imaging studies is necessary to determine the appropriateness of this procedure.

5. When to use CPT code 27279

It is appropriate to bill the 27279 CPT code when a provider performs the arthrodesis of the sacroiliac joint as described in the procedure section. This code should be used when the patient meets the qualifying circumstances and the procedure is deemed medically necessary by the provider.

6. Documentation requirements

To support a claim for CPT 27279, the following information should be documented:

• Patient’s medical history, including previous treatments and their outcomes.
• Physical examination findings, including the presence of pain and instability in the sacroiliac joint.
• Imaging studies, such as X-rays, CT scans, or MRI, showing evidence of sacroiliac joint dysfunction or instability.
• Indication of the medical necessity of the procedure, including the failure of conservative treatments.
• Detailed description of the procedure performed, including the use of image guidance and any bone graft obtained.
• Postoperative care plan, including the use of a pelvic cast and follow-up appointments.

7. Billing guidelines

When billing for CPT code 27279, it is essential to follow the appropriate guidelines and rules. Do not report 27279 in conjunction with 0775T. For percutaneous arthrodesis of the sacroiliac joint utilizing both a transfixation device and intra-articular implant(s), use 27299. For percutaneous arthrodesis of the sacroiliac joint by intra-articular implant(s), use 0775T. For bilateral procedures, report 27279 with modifier 50.

8. Historical information

CPT 27279 was added to the Current Procedural Terminology system on January 1, 2015. There have been no updates since its addition.

9. Similar codes to CPT 27279

Five similar codes to CPT 27279 and how they differentiate are:

1. CPT 27280: Arthrodesis of the sacroiliac joint without image guidance.
2. CPT 27299: Percutaneous arthrodesis of the sacroiliac joint utilizing both a transfixation device and intra-articular implant(s).
3. CPT 0775T: Percutaneous arthrodesis of the sacroiliac joint by intra-articular implant(s).
4. CPT 22558: Arthrodesis of the lumbar spine, anterior approach.
5. CPT 22585: Arthrodesis of the cervical spine, anterior approach.

10. Examples

Here are 10 detailed examples of CPT code 27279 procedures:

1. A 45-year-old patient with chronic sacroiliac joint pain due to degenerative joint disease undergoes arthrodesis with image guidance and bone graft.
2. A 35-year-old patient with sacroiliac joint instability following a motor vehicle accident undergoes arthrodesis using image guidance and fixation devices.
3. A 55-year-old patient with sacroiliac joint dysfunction due to osteoarthritis undergoes arthrodesis with image guidance and placement of a transfixing device.
4. A 40-year-old patient with sacroiliac joint pain and instability due to ankylosing spondylitis undergoes arthrodesis using image guidance and bone graft.
5. A 50-year-old patient with sacroiliac joint dysfunction following a fall undergoes arthrodesis with image guidance and fixation devices.
6. A 60-year-old patient with chronic sacroiliac joint pain due to rheumatoid arthritis undergoes arthrodesis using image guidance and placement of a transfixing device.
7. A 30-year-old patient with sacroiliac joint instability due to a sports injury undergoes arthrodesis with image guidance and bone graft.
8. A 65-year-old patient with sacroiliac joint dysfunction due to degenerative joint disease undergoes arthrodesis using image guidance and fixation devices.
9. A 70-year-old patient with sacroiliac joint pain and instability due to osteoarthritis undergoes arthrodesis with image guidance and placement of a transfixing device.
10. A 47-year-old patient with sacroiliac joint dysfunction following a work-related injury undergoes arthrodesis using image guidance and bone graft.