ࡱ> S@ #bjbj %c04448$5Dh5AD88.8.8.8.8.8.8CCCCCCC$DRIGC.8.8.8.8.8C.8.8CF9F9F9.8.8.8CF9.8CF9"F9h9h9.8 8 Ps 48Rh99< D0ADh9)H9")Hh9)Hh9.8.8F9.8.8.8.8.8CC0h309h3Appendix: ICD-9-CM Inclusion and Exclusion Codes for Lumbar Surgery Table 1: Codes for Exclusions in Surgical Case Finding. A case with any of these codes is excluded, no matter what other code may be present. Exclude all patients <20.0 years of age as of the listed discharge date. Then: Exclude if listed in any diagnosis field:ICD-9-CM Diagnosis CodeDescription140-239.9All neoplasms324.1Intraspinal abscess630-676Pregnancy-related diagnoses720.0-720.9Inflammatory spondyloarthropathies730-730.99Osteomyelitis733.1, 733.10, 733.13, 733.95Pathologic fracture, including unspecified site (733.10) or vertebrae (733.13), or stress fracture of other bone.733.8, 733.81-733.82Non-union/mal-union of fracture 805-806.9Fractures of spinal column839-839.59All vertebral dislocationsE800-E849.9Vehicular accidents Exclude if listed as first diagnosis; do not exclude if it is a secondary diagnosisICD-9-CM Diagnosis CodeDescription353.2, 353.3Cervical/thoracic root lesion721.0, 721.2 Cervical/thoracic spondylosis without myelopathy721.1, 721.41Cervical/thoracic spondylosis with myelopathy722.0, 722.11Displacement cervical/thoracic disc722.4Degeneration of cervical disc722.71, 722.72Cervical/thoracic disc disease with myelopathy722.81, 722.82Cervical/thoracic disc post laminectomy syndrome722.91, 722.92Unspecified disc disorder, cervical/thoracic723.0Cervical spinal stenosis723.4Brachial neuritis Exclude if listed in any procedure fieldICD-9-CM Proc CodeDescription03.2-03.29Chordotomy81.01Atlas-axis fusion81.02Cervical fusion, anterior approach81.03Cervical fusion, posterior approach Table 2: Diagnosis Codes for Definite Lumbar Surgery. A case with any procedure code in Table 6, and any diagnosis code in Table 2, is selected as definitely lumbar. A case with any procedure code in Table 5 is selected as definite, regardless of diagnosis (provided that the case isnt excluded by codes in Table 1). ICD-9-CM Diagnosis CodeDescription Herniated Disc722.10Displacement of lumbar disc722.73Herniated lumbar disc with myelopathy Disc Degeneration721.3Lumbosacral spondylosis, no myelopathy722.52Degeneration of lumbar disc722.93Lumbar disc calcification Spinal Stenosis721.42Spondylogenic compression of lumbar spinal cord724.02Lumbar stenosis Possible Instability724.6Disorders of sacrum: includes instability of lumbosacral joint738.4Acquired spondylolisthesis (included because these are overwhelmingly lumbar)756.11Spondylolysis, lumbar756.12Spondylolisthesis (included because these are overwhelmingly lumbar) Miscellaneous low back problems722.32Schmorls node, Lumbar region722.83Postlaminectomy syndrome, lumbar724.2Lumbago724.3Sciatica739.3Non-allopathic lesions, lumbar spine739.4Non-allopathic lesions, sacral region846.0-846.9Sprains and strains, lumbosacral and other sacral ligaments 847.2Sprains and strains, lumbar847.3Sprains and strains, sacral Table 3: Diagnosis codes for Possible Lumbar Surgery. A case with any procedure code (including 78.69) in Table 6, and any diagnosis code in Table 3 (but no code in Table 2), is selected as possibly lumbar. ICD- 9-CM Diagnosis CodeDescription721.5Kissing spine721.9-721.91Spondylosis, unspecified site721.90, 721.91722.2Herniated disc, unspecified site722.39Schmorls node, site unspecified722.6Degeneration intervertebral disc, unspecified site722.70Intervertebral disc disorder with myelopathy, site unspecified722.80Post-laminectomy syndrome, unspecified region724.00Stenosis, unspecified site, not cervical724.09Stenosis, other, not cervical724.4Thoracic or lumbosacral neuritis or radiculitis724.5Backache, unspecified724.8Other symptoms referable to back724.9Other unspecified back disorders847.9Sprain and strain, unspecified part of back Table 4. Diagnosis codes for Possible Lumbar Surgery when there is a procedure from Table 6 other than 78.50, 78.59, 78.60, 78.69. A case with any procedure code other than 78.50, 78.59, 78.60, or 78.69 in Table 6, and any diagnosis code in this Table (but no code in Table 2 or Table 3), is selected as possible. If there is no procedure code but 78.50, 78.59, 78.60, or 78.69 in Table 6, and a diagnosis code in Table 4 but not Table 2 or 3, the case is not selected because it may not involve the spine. ICD-9-CM Diagnosis CodeDescription996.4Mechanical complication of orthopdic device996.60, 996.63, 996.67Infection and inflammation reaction due to internal prosthetic device, implant, and graft996.70Complications of internal prosthetic device996.75Complications of nervous system device/graft 996.78Complications of other internal orthopdic device E878.1Abnormal reaction to implantV45.4Arthrodesis statusV54.0Removal of internal fixation device Table 5: Lumbar-specific ICD-9-CM Procedure Codes, requiring no specific Dx code. A case with a code from Table 5 is always definite (unless excluded by Table 1). ICD-9-CM Procedure Code DescriptionFusion81.06Lumbar and lumbosacral spinal fusion, anterior technique81.07Lumbar and lumbosacral spinal fusion, lateral transverse process technique81.08Lumbar and lumbosacral spinal fusion, posterior technique Table 6: Back-specific (or possibly back-related) ICD-9-CM procedure codes (which do not specify lumbar spine). A case with a code from this Table is selected as definite if there is also a diagnosis from Table 2. Remaining cases with a code from this Table are selected as possible if there is also a diagnosis from Table 3, or from Table 4 as long as there is a code from this Table other than (or in addition to) 78.69. If there is no diagnosis from Table 2, 3 or 4 (or if there is any code from Table 1), the case is not selected. If there is no procedure code but 78.69 , and a diagnosis from Table 4 but not from Tables 2 or 3, the case is not selected ICD-9-CM Procedure Code Description Laminectomy03.0 Exploration and decompression of spinal canal structures03.09Other exploration and decompression of spinal canal Discectomy80.5Excision or destruction of intervertebral disc80.50Excision or destruction of intervertebral disc unspecified80.51Excision of intervertebral disc80.52Intervertebral chemonucleolysis80.59Other destruction of intervertebral disc Fusion81.00, 81.0Spinal fusion, not otherwise specified81.04Dorsal/dorsolumbar fusion, anterior technique81.05Dorsal/dorsolumbar fusion, posterior technique81.09Refusion of spine, any level, any technique Other03.02Reopening of laminectomy site03.6Lysis of adhesions of cord or nerve root79.50, 78.59Internal fixation of bone without fracture reduction78.60, 78.69Removal of internal fixation device (vertebral, pelvic, or phalangeal)78.90, 78.99Insertion of bone growth stimulator Trends in Lumbar Fusion Surgery  PAGE 3 DEL~% & ' < ? 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