ࡱ>   '` :$bjbj{P{P ::%       4>***h$>"ЊЊЊЊЊЊ~$h ЊЊЊЊЊ  ЊЊʗʗʗЊ  Њ Њ~ʗЊ~ʗʗ  ʗЊ 9Y-*pʗ"\Ϧ0ʗ`ʗ ʗXЊЊʗЊЊЊЊЊ"ЊЊЊЊЊЊЊ>> d;FL:>>FL>>>       Appendix 1: Surgical CPT Codes CPT4 CodeDescription20930Allograft for spine surgery only, morselized20931Allograft for spine surgery only, structural20936Autograft for spine surgery only, local20937Autograft for spine surgery only, morselized20938Autograft for spine surgery only, structural22548Arthrodesis, anterior transoral or extraoral technique22558Arthrodesis, anterior interbody technique, including minimal discectomy, lumbar22585Arthrodesis, anterior approach, lumbar, each additional interspace22612Arthrodesis, posterior or posterolateral technique, lumbar22614Arthrodesis, posterior or posterolateral technique, each additional vertebral segment22630Arthrodesis, posterior interbody technique, lumbar22632Arthrodesis, posterior interbody technique, each additional interspace22830Exploration of spinal fusion22840Posterior non-segmental instrumentation22841Internal spinal fixation by wiring of spinous processes 22842Posterior segmental instrumentation, 3-6 vertebral segments22843Posterior segmental instrumentation, 7-12 vertebral segments22844Posterior segmental instrumentation, 13+ vertebral segments22845Anterior instrumentation, 2-3 vertebral segments22846Anterior instrumentation, 4-7 vertebral segments22847Anterior instrumentation, 8+ vertebral segments22849Reinsertion of spinal fixation device22850Removal of posterior nonsegmental instrumentation22851Application of intervertebral biomechanical device22852Removal of posterior segmental instrumentation22855Removal of anterior instrumentation63005Laminectomy with exploration and/or decompression, 1-2 vertebral segments, lumbar63011Laminectomy with exploration and/or decompression, 1-2 vertebral segments, sacral63012Laminectomy with removal of abnormal facets .. with decompression, lumbar63017Laminectomy with exploration and/or decompression, >2 vetebral segments, lumbar63030Laminotomy (hemilaminectomy) with decompression, 1 interspace, lumbar63035Laminotomy (hemilaminectomy) with decompression, each additional interspace, cervial or lumbar63042Laminotomy (hemilaminectomy) with decompression, reexploration, 1 interspace, lumbar63044Laminotomy (hemilaminectomy) with decompression, reexploration, each additional lumbar interspace63047Laminectomy, facetectomy, and foraminotomy with decompression, 1 vertebral segment, lumbar63048Laminectomy, facetectomy, and foraminotomy with decompression, each additional vertebral segment63056Transpedicular approach with decompression, 1 segment, lumbar63057Transpedicular approach with decompression, each additional segment, lumbar63170Laminectomy with myelotomy, cervical, thoracic, or thoracolumbar63185Laminectomy with rhizotomy, 1-2 segments63190Laminectomy with rhizotomy, more than 2 segments63200Laminectomy, with release of tethered spinal cord, lumbar63267Laminectomy with excision or evacuation of intraspinal lesion other than neoplasm, lumbar63268Laminectomy with excision or evacuation of intraspinal lesion other than neoplasm, sacral63272Laminectomy for excision of intraspinal lasion other than neoplasm, lumbar63273Laminectomy for excision of intraspinal lasion other than neoplasm, sacral22224Osteotomy of spine, including didcectomy, lumbar22226Osteotomy of spine, including didcectomy, each additional segment62287Aspiration or decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc (e.g., percutaneous discectomy, percutaneous laser discectomy)69990Microsurgical techniques, requiring use of operating microscope Appendix 2: Low Back Injury Severity Code Groups Based on ICD-9 Codes ICD-9 CodeDescriptionMore Severe344.60Syndrome, cauda equina NOS344.61Synd, cauda equina w/neuro bladder353.1Lesions, lumbosacral plexus353.4Lesions, lumbosacral root NEC353.8Disorder, nerve root/plexus NEC353.9Disorder, nerve root/plexus NOS355.0Lesion, sciatic nerve721.42Spondylosis, lumbar w/myelopathy722Disorders, intervertebral disc722.1Dsplcmnt thorc/lmbr disc w/o myelpy722.10Dsplcmnt, lumbar disc w/o myelpy722.2Displacement, disc NOS w/o myelpy722.7Dsord, intervertebral disc w/myelpy722.70Disorder, disc NOS w/myelopathy722.73Disorder, lumbar disc w/myelopathy722.83Syndrome, postlaminectomy, lumbar724.0Stenosis, spinal, oth than cervical724.00Stenosis, spinal, unspec region724.02Stenosis, spinal, lumbar724.09Stenosis, spinal, other spec site724.3Sciatica724.4Neuritis, lumbosacral NOS724.6Disorders, sacrum (incl. LS jt. instability)729.2Neuralgia/neuritis NOS738.4Spondylolisthesis, acquired756.1Anomaly, congenital, spine756.10Anomaly, congenital, spine NOS756.11Spondylolysis, cngn, lumbosacral756.12Spondylolisthesis, congenital953.2Injury, lumbar root953.5Injury lumbosacral plexus956.0Injury sciatic nerveLess Severe349.9Disorder, nervous system NOS720.0Spondylitis, ankylosing720.1Enthesopathy, spinal720.2Sacroiliitis NEC720.9Spondylopathy, inflammatory NOS721.3Spondylosis, lumbosacral721.7Spondylopathy, traumatic721.8Disorder, spinal NEC721.9Spondylosis NOS721.90Spondylosis NOS w/o myelopathy722.32Schmorl's nodes, lumbar region722.5Dgnratn, thorc/lumbar disc722.52Degeneration, lumbar/lmbsac disc722.6Degeneration, disc NOS722.9Dsord, intrvrtbrl disc, oth & unspc722.90Disorder NEC/NOS, unspecified disc722.93Disorder NEC/NOS, lumbar disc724 Disorders, back, other & unspc724.2 Lumbago724.5 Backache NOS724.7Disorders, coccyx724.71Hypermobility, coccyx724.79Disorder, coccyx NEC724.8 Symptom, back NEC724.9 Disorder, back NOS728.2 Atrophy, muscular disuse NEC728.8 Disorders, muscle/ligament/fascia728.85 Spasm, muscle728.9 Disorder, muscle/ligament NOS729.1 Myalgia/myositis NOS729.9 Disorder, soft tissue NEC/NOS737.3Kyphoscoliosis and scoliosis737.30Scoliosis, idiopathic737.39Scoliosis NEC738.5Deformity, acquired, back/spine NEC739.3Lesion, nonallopathic, lumbar rgn739.4Lesion, nonallopathic, sacral rgn756.15Fusion, spine, congenital793.7Nonspecif abnl radiolog fnd, musculoskl systm799.8 Condition, ill-defined NEC839.2Dsloc, thoracic/lumbar vrt, clsd839.20Dsloc lumbar vertebra, closed839.42Dislocation sacrum, closed839.69Dislocation site NEC, closed839.8Dislocation, mlt/ill-defined, clsd846 Sprain/strain, sacroiliac region846.0 Sprain/strain, lumbosacral846.1 Sprain/strain, sacroiliac ligament846.2 Sprain/strain, sacrospinatus846.3Sprain/strain, sacrotuberous846.8 Sprain/strain, sacroiliac site NEC846.9 Sprain/strain, sacroiliac site NOS847 Sprains/strain oth/unspc parts back847.2 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" ( t u { % & , f g m ( ) / z {   M N T :;"@AGghn#$+LMSuv|$HIPpqx !'>?Eabh56<QRST`ag%>?EZ[aqry  ()/ST[~%&-BCJ\]dwx  !(FGMjkr#=>Drsz+,2UV[|}>?Fijo./6HIPklr;@U:0@UnknownG:Ax Times New Roman5Symbol3& :Cx ArialcMS Sans SerifTimes New Roman"1hFF0202qF4d6qKX ?=%+2Appendix 1: Surgical CPT Codesn0013291n0013291Oh+'0 ( H T `lt| Appendix 1: Surgical CPT Codes n0013291Normal n00132913Microsoft Office Word@@$F-@$F-0՜.+,0 hp  Liberty Mutual2' Appendix 1: Surgical CPT Codes Title  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuwxyz{|}~ Root Entry FY- Data vsS1TableWordDocumentSummaryInformation(DocumentSummaryInformation8CompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q