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Prior to July 1, 2023, there were two (2) Category I CPT codes and one (1) Category III codes for sacroiliac arthrodesis:
- 27279: Arthrodesis, sacroiliac joint, percutaneous or minimally invasive (indirect visualization), with image guidance, includes obtaining bone graft when performed, and placement of transfixing device
- 27280: Arthrodesis, sacroiliac joint, open, includes obtaining bone graft, including instrumentation, when performed
- 0775T: Arthrodesis, sacroiliac joint, percutaneous, with image guidance, includes placement of intra-articular implant(s) (eg, bone allograft[s], synthetic device[s]
Note: Prior to July 1, 2023, 27279 and 0775T describe “percutaneous or minimally invasive” approaches; CPT code 27280 describes an open approach.
In January 2023, the AMA released a new Category III code that became effective for reporting on July 1, 2023. While effective July 1, 2023, this code will be published in the 2024 CPT Manual as a new Category III code.
The new code is: 0809T (Arthrodesis, sacroiliac joint, percutaneous or minimally invasive (indirect visualization), with image guidance, placement of transfixing device(s) and intraarticular implant(s), including allograft or synthetic) and looks very similar to CPT code 27279 and 0775T. This category III code (0809T) may be reported with a modifier 50 as a bilateral procedure when performed.
As of July 1, 2023, CPT recognizes 3 percutaneous or minimally invasive approach codes and 1 open approach CPT code.
What is different between 27279, 0775T and 0809T code since they all describe a percutaneous or minimally invasive approach?
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CPT code 27279 describes an arthrodesis that includes the placement of one or more transfixing devices; this code also includes obtaining bone graft, if performed regardless of same or different incision
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Category III code 0775T describes an arthrodesis that includes placement of intra-articular implants, such as bone allografts or synthetic devices.
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Category III code 0809T combines the work of both 27279 and 0775T into one code. Category III code, 0089T includes placement of one or more transfixing devices and intraarticular implant(s and allograft or synthetic grafts versus harvesting the bone graft from the same or separate incision.
Category III codes have no assigned RVUs. Set your fee based on a comparison code, for example, 27279 plus additional work for the placement of the intraarticular implants. Explain this is more complex or less complex to justify your fee. The payment status code for 0809T indicates that this is a carrier priced code.
Have the patient sign a waiver or ABN in the event the payor denies as experimental or not medically necessary.
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