Utility of a Combined Current Procedural Terminology and International Classification of Diseases, Ninth Revision, Clinical Modification Code Algorithm in Classifying Cervical Spine Surgery for Degenerative Changes
ABSTRACT Retrospective study.
To evaluate the sensitivity and specificity of a combined Current Procedural Terminology (CPT) and International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) algorithm in defining cervical spine surgery in comparison to patient operative reports in the medical record.
Epidemiological studies of spine surgery often use ICD-9-CM billing codes in administrative databases to study trends and outcome of surgery. However, ICD-9-CM codes do not clearly identify specific surgical factors that may be related to outcome, such as instrumentation or number of levels treated. Previous studies have not investigated the sensitivity and specificity of a combined CPT and ICD-9-CM code algorithm for defining cervical spine surgical procedures.
We performed a retrospective study comparing the sensitivity and specificity of a combined CPT and ICD-9-CM code algorithm to the operative note, the gold standard, in a single academic center. We also compared the accuracy of our combined algorithm with our published ICD-9-CM-only algorithm.
The combined algorithm has high sensitivity and specificity for defining cervical spine surgery, specific surgical procedures such as discectomy and fusion, and surgical approach. Compared to the ICD-9-CM-only algorithm, the combined algorithm significantly improves identification of discectomy, laminectomy, and fusion procedures and allows identification of specific procedures such as laminaplasty and instrumentation with high sensitivity and specificity. Identification of reoperations has low sensitivity and specificity, but identification of number of levels instrumented, fused, and decompressed has high specificity.
The use of our combined CPT and ICD-9-CM algorithm to identify cervical spine surgery was highly sensitive and specific. For categories such as surgical approach, accuracy of our combined algorithm was similar to that of our ICD-9-CM-only algorithm. However, the combined algorithm improves sensitivity, and allows identification of procedures not defined by ICD-9-CM procedure codes, and number of levels instrumented and decompressed. The combined algorithm better defines cervical spine surgery and specific factors that may impact outcome and cost.
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ABSTRACT: We reviewed existing methods for identifying patients with neck and back pain in administrative data. We compared these methods using data from the Department of Veterans Affairs. To answer the following questions: (1) what diagnosis codes should be used to identify patients with neck pain and back pain in administrative data; (2) because the majority of complaints are characterized as nonspecific or mechanical, what diagnosis codes should be used to identify patients with nonspecific or mechanical problems in administrative data; and (3) what procedure and surgical codes should be used to identify patients who have undergone a surgical procedure on the neck or back. Musculoskeletal neck and back pain are pervasive problems, associated with chronic pain, disability, and high rates of health care utilization. Administrative data have been widely used in formative research, which has largely relied on the original work of Volinn, Cherkin, Deyo, and Einstadter and the Back Pain Patient Outcomes Assessment Team first published in 1992. Significant variation in reports of incidence, prevalence, and morbidity associated with these problems may be due to nonstandard or conflicting methods to define study cohorts. A literature review produced 7 methods for identifying neck and back pain in administrative data. These code lists were used to search Veterans Health Administration data for patients with back and neck problems, and to further categorize each case by spinal segment involved, as nonspecific/mechanical and as surgical or not. There is considerable overlap in most algorithms. However, gaps persist. Gaps are evident in existing methods and a new framework to identify patients with neck pain and back pain in administrative data is proposed.Spine 11/2011; 37(10):860-74. DOI:10.1097/BRS.0b013e3182376508 · 2.45 Impact Factor
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ABSTRACT: Retrospective review of medical records. We reviewed all early readmissions after elective spine surgery at a single orthopedic specialty hospital to analyze the causes of unplanned readmissions. Recent advances in techniques and instrumentation have made more complex spinal surgeries possible, although sometimes with more complications. Early readmission rate is being used as a marker to evaluate quality of care. There is little data available regarding the causes of early readmissions after spine surgery. Using the hospital's administrative database of patient records from 2007 to 2009, all patients who underwent spine surgery and were readmitted to the hospital within 30 days were identified and broadly categorized as planned (a staged or rescheduled procedure or a direct transfer) or unplanned. Unplanned readmissions were defined to have occurred as a result of either a surgical or a nonsurgical complication. Analysis was focused on 12 common spine procedures based on the principle procedure International Classification of Diseases, Ninth Revision, Clinical Modification code for the patient's initial admission. The readmission rate was calculated for each procedure. A total of 156 early readmissions were identified, of which 141 were unplanned. Of the unplanned readmissions, the most common causes were infection or a concern for an infection (45 patients, 32% of unplanned readmissions), nonsurgical complications (31 patients, 22% of readmissions), complications requiring surgical revision (21 patients, 15% of readmissions), and wound drainage (12 patients, 9% of readmissions). Fifty-seven percent of unplanned readmissions required a return to the operating room (76% of infections or concern for infection). The average length of stay for the unplanned readmissions was 6.5 days. When using the 12 most common procedures based on the International Classification of Diseases, Ninth Revision, Clinical Modification, the early readmission rate was 3.8% (141 early readmissions in 3673 procedures). Infection, medical complications after surgery, and surgical complications requiring revision of implants are the primary causes of unplanned early readmissions and spine surgery. Further studies are necessary to identify patients and procedures most associated with readmission.Spine 06/2012; 37(14):1260-6. DOI:10.1097/BRS.0b013e318245f561 · 2.45 Impact Factor
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ABSTRACT: Study Design. Retrospective analysis of a population-based database. Objective. To investigate national epidemiological trends of cervical spine surgical procedures from 2002-2009. Summary of Background Data. Anterior cervical fusion (ACF), posterior cervical fusion (PCF), and posterior cervical decompression (PCD) are procedures routinely performed for cervical degenerative pathology. Studies regarding epidemiological trends of these procedures is currently lacking in the literature. Methods. Data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project was obtained for each year between 2002 and 2009. Patients undergoing ACF, PCF, and PCD for the diagnosis of cervical radiculopathy and myelopathy were identified. Demographics, costs, and mortality were assessed in the surgical subgroups. A P value of 0.001 was used to denote significance. Results. An estimated 1,323,979 cervical spine surgical procedures were performed between 2002 and 2009. There was a significant upward trend in the mean age of patients undergoing cervical spine surgery during this time period. ACF and PCF cohorts demonstrated statistically significant increases in comorbidities and costs from 2002-2009. The PCF group had the greatest mortality, comorbidities, costs, and longest hospitalizations compared with ACF and PCF cohorts across all time periods. Conclusion. Our study demonstrates that cervical spine surgical procedures have increased between 2002 and 2009 (P = 0.001). The primary increase in volume is due to the increasing number of ACFs. Despite older patients with more comorbidities undergoing ACF and PCF procedures, mortality has not changed. However, this time period. We hypothesize that these increased costs are due to an increased comorbidity burden in patients undergoing ACF or PCF. Results of this study can be used to set benchmarks for future epidemiological investigations in cervical spine surgery.Spine 02/2013; 38(14). DOI:10.1097/BRS.0b013e31828be75d · 2.45 Impact Factor