Physician Feature: Dr. Gerard Librodo
Sacroiliac (SI) joint dysfunction is not a new condition inour practice. In fact, I have been treating these patients conservatively for more than 10 years. Surgically repairing the SI joint wasn’t out of the question, but until recently I wasn’t comfortable with the surgical options available. As an orthopedic surgeon, I’m all about bony fusion. Until I found a system that allowed me to fuse the SI joint by means of bleeding bone, grafting and fixation, I was reluctant recommending a surgical solution for this condition.
The SImmetry System from Zyga is the only system I have found that utilizes decortication in the joint to gain a fusion. After 10 years of treating patients with SI joint problems, this was the first one that “clicked” with me. I appreciate the ability to truly fuse the joint, instead of sliding a peg through it, and the controlled implantation the procedure allows.
As with all procedures, diagnosis and proper patient selection are vital; especially when dealing with the SI joint. Many SI joint symptoms can mimic other problems; for instance, facet pain can often be confused with SI joint pain. Conditions must be differentiated from one another.
My back pain patients often arrive with no imaging, so I start with MRI and analysis of symptoms. If the MRI shows facet arthropathy, I’ll send them for a medial branch block. If not, I proceed to SI joint. I suspect the SI joint if the patient is complaining of tenderness in the SI joint, or pain in what they call their “hip”. Often these patients can hardly sit on the affected side, so you see them sitting on the contralateral side. If they’re hurting on both sides, there is usually restless shifting from side to side. Patients may complain of pain radiating to the posterior thigh, but it usually stops at the knee.
I incorporate a few SI-specific tests into my exam, including the Fortin finger test, Gaenslen, FABER, Compression, Pelvic Thrust and Distraction. If at least three of these are positive, I order diagnostic injections. I prefer to send my patients out for diagnostic injections in order to avoid any potential bias. Before recommending surgery, I like to see at least 80% relief from two injections.
I’ve now been performing SI joint fusions for nearly a year. Overall, I feel good about my outcomes with the SImmetry System. In fact, I have one patient who was begging me to be full-weight-bearing soon after surgery because he felt so good. It was hard to keep him from walking. This has been a great addition to my practice, allowing me to offer a long-term, surgical solution to a significant group of patients for whom I previously had no answers. That’s a great feeling.
Gerard Librodo, M.D.
Dr. Librodo served his residency at Makati Medical Center in the Philippines. He has fellowship training in pediatric orthopedics at Cincinnati Children’s Hospital, and fellowships focusing on orthopedic surgery of the spine at both the Hospital for Special Surgery in New York and at Southern Illinois University School of Medicine.
2016 Reimbursement Update
As of February 1st, six out of the eight Medicare Administrative Contractors (MAC) now offer coverage for sacroiliac joint fusion. The seventh MAC, National Government Services (NGS), is expected to support coverage within the next few months in the following states: Connecticut, Illinois, Maine, Massachusetts, Minnesota, New Hampshire, New York, Rhode Island, Vermont and Wisconsin.
>Since the implementation of ICD-10, the following codes are now being used by hospitals to report SIJ fusion when performed inpatient:
0SG734Z – Fusion of the right sacroiliac joint with fixation device, percutaneous approach.
0SG834Z – Fusion of the left sacroiliac joint with fixation device, percutaneous approach.
If a bilateral procedure is performed, then both codes will be listed on the claim form.
Both codes are still grouped to DRG 460 (unilateral and bilateral procedures) and the 2016 payment rate (effective October 1st) is $23,156.56 unadjusted.
However, these new codes do not impact the hospital outpatient, ASC, or surgeon coding. These stakeholders will still report 27279.
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International Society for the Advancement of Spine Surgery (ISASS) | April 6-8 | Las Vegas, NV
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