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Official Description

Arthrodesis, sacroiliac joint, percutaneous, with image guidance, including placement of intra-articular implant(s) (eg, bone allograft[s], synthetic device[s]), without placement of transfixation device

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

Sacroiliac (SI) joint arthrodesis is a surgical procedure aimed at creating a fusion between the sacrum, which is the triangular bone at the base of the spine, and the ilium, the uppermost part of the pelvis. This procedure is typically indicated for patients suffering from severe and persistent joint pain, often resulting from conditions such as fractures or arthritis that have not responded to conservative treatments. The goal of the arthrodesis is to alleviate pain by inducing ossification, or bone formation, in the affected joint. During the procedure, a bone allograft, which is a graft taken from a donor, or a synthetic bone substitute is implanted into the sacroiliac joint space. The technique employed is percutaneous, meaning it is minimally invasive, and utilizes image guidance, such as fluoroscopy, to accurately navigate to the joint area. This approach minimizes tissue damage and promotes quicker recovery times compared to traditional open surgery. The procedure does not involve the placement of a transfixation device, which is often used in other types of joint fusions to stabilize the joint during the healing process. Instead, the focus is on the precise placement of the graft material to facilitate the fusion of the joint.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The procedure of sacroiliac joint arthrodesis is indicated for patients experiencing severe and intractable pain in the sacroiliac joint, which may be due to various underlying conditions. The following are the explicitly provided indications for this procedure:

  • Intractable Joint Pain - Patients suffering from persistent pain that has not responded to conservative treatment options.
  • Fracture - Pain resulting from fractures in the sacroiliac joint area.
  • Arthritis - Joint pain associated with arthritic conditions affecting the sacroiliac joint.

2. Procedure

The procedure of sacroiliac joint arthrodesis involves several key steps that are performed with precision to ensure successful fusion of the joint. The following procedural steps are outlined:

  • Step 1: Preparation and Imaging - The patient is positioned appropriately, and fluoroscopic imaging is utilized to identify the exact location of the sacroiliac joint. This imaging is crucial for guiding the subsequent steps of the procedure.
  • Step 2: Incision and Access - A small incision is made in the skin over the targeted area, and the incision is extended down to the fascia of the gluteal muscle. This allows access to the sacroiliac joint while minimizing damage to surrounding tissues.
  • Step 3: Muscle Penetration and Pin Placement - The gluteal muscle is carefully penetrated, and a hollow pin is inserted to create holes for the implants. This step is essential for facilitating the placement of the graft material into the joint space.
  • Step 4: Joint Decortication - The joint space is decorticated using a surgical drill or other decortication devices. This process prepares the bone surfaces for optimal graft integration by removing the outer layer of bone.
  • Step 5: Graft Insertion - Bone grafting material, either bone allograft or a synthetic substitute, is inserted through the hollow pin into the decorticated joint space. This material is critical for promoting the fusion of the sacroiliac joint.
  • Step 6: Additional Implant Placement - To prevent damage to nearby nerves, additional implants are strategically placed between the foramen openings at the S1 and S2 vertebrae. This step enhances the stability of the joint during the healing process.
  • Step 7: Packing and Closure - The bone grafting material is packed into place to ensure proper fusion of the SI joint. Finally, the fascia and skin are closed, completing the procedure.

3. Post-Procedure

After the sacroiliac joint arthrodesis procedure, patients can expect a recovery period that may involve pain management and rehabilitation. Post-operative care typically includes monitoring for any signs of complications, such as infection or improper healing. Patients are often advised to limit weight-bearing activities and may require physical therapy to regain strength and mobility in the affected area. The overall recovery time can vary based on individual factors, but the minimally invasive nature of the procedure generally allows for a quicker return to daily activities compared to traditional open surgical methods.

Short Descr ARTHRD SI JT PRQ WO TFXJ DEV
Medium Descr ARTHRD SI JT PRQ W/PLMT IARTIC IMPLT WO TFXJ DEV
Long Descr Arthrodesis, sacroiliac joint, percutaneous, with image guidance, including placement of intra-articular implant(s) (eg, bone allograft[s], synthetic device[s]), without placement of transfixation device
Status Code Active Code
Global Days 090 - Major Surgery
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 1 - 150% payment adjustment for bilateral procedures applies.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 0 - Co-surgeons not permitted for this procedure.
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) none
MUE 1
RT Right side (used to identify procedures performed on the right side of the body)
LT Left side (used to identify procedures performed on the left side of the body)
50 Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d).
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
53 Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
62 Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate.
74 Discontinued out-patient hospital/ambulatory surgery center (asc) procedure after administration of anesthesia: due to extenuating circumstances or those that threaten the well being of the patient, the physician may terminate a surgical or diagnostic procedure after the administration of anesthesia (local, regional block(s), general) or after the procedure was started (incision made, intubation started, scope inserted, etc). under these circumstances, the procedure started but terminated can be reported by its usual procedure number and the addition of modifier 74. note: the elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. for physician reporting of a discontinued procedure, see modifier 53.
78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
82 Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s).
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
FB Item provided without cost to provider, supplier or practitioner, or full credit received for replaced device (examples, but not limited to, covered under warranty, replaced due to defect, free samples)
GA Waiver of liability statement issued as required by payer policy, individual case
GC This service has been performed in part by a resident under the direction of a teaching physician
SG Ambulatory surgical center (asc) facility service
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
Date
Action
Notes
2024-01-01 Added Code Added.
Code
Description
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