APPENDIX TABLES
Appendix Table 1: Codes for cases to be excluded. A case with any of these codes is excluded, regardless of other codes that 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 Code / Description
140-239.9 / All neoplasms
324.1 / Intraspinal abscess
630-676 / Pregnancy-related diagnoses
720.0-720.9 / Inflammatory spondyloarthropathies
730-730.99 / Osteomyelitis
733.1, 733.10, 733.13 / Pathologic fracture, incl unspecified site (733.10) or vertebrae (733.13)
733.8, 733.81-733.82 / Non-union/mal-union of fracture
805-806.9 / Fractures of spinal column
839-839.59 / All vertebral dislocations
E800-E849.9 / Vehicular accidents
Exclude if listed as first diagnosis; do not exclude if it is a secondary diagnosis
ICD-9-CM Diagnosis Code / Description
353.2, 353.3 / Cervical/thoracic root lesion
721.0, 721.2 / Cervical/thoracic spondylosis without myelopathy
721.1, 721.41 / Cervical/thoracic spondylosis with myelopathy
722.0, 722.11 / Displacement cervical/thoracic disc
722.4 / Degeneration of cervical disc
722.71, 722.72 / Cervical/thoracic disc disease with myelopathy
722.81, 722.82 / Cervical/thoracic disc post laminectomy syndrome
722.91, 722.92 / Unspecified disc disorder, cervical/thoracic
723.0 / Cervical spinal stenosis
723.4 / Brachial neuritis
724.01 / Thoracic spinal stenosis
Exclude if listed in any procedure field
CPT-4 Procedure Code / Description
22554 / Neck spine fusion
22556 / Thoracic spine fusion
22600 / Cervical arthrodesis, posterior approach
63020 / Cervical laminotomy
63075 / Diskectomy, cervical, anterior (R84)
63076 / Neck spine surgery
ICD-9-CM Procedure Code / Description
03.2-03.29 / Chordotomy
81.01 / Atlas-axis fusion
81.02 / Other cervical fusion
81.03 / Dorsal fusion
Appendix Table 2: Lumbar-specific ICD-9-CM procedure codes, requiring no specific diagnosis code. A case with a code from Table 2 is always “definite” (unless excluded by Table 1).
Description
Fusion
81.06 / Lumbar spinal fusion
81.07 / Lumbosacral spinal fusion
81.08 / Refusion of spine (coding specified lumbar spine as of mid-late 1990s)
Appendix Table 3. : Lumbar-specific CPT-4 procedure codes, requiring no specific diagnosis code. A case with a code from Table 3 is always “definite” (unless excluded by Table 1).
CPT-4 Procedure Code / DescriptionLumbar Diskectomy
63030 / Laminotomy w/Partial Facetectomy/Foraminotomy/Herniated Diskectomy; 1 Interspace, Lumbar
63042 / Laminotomy w/Partial Facetectomy/Foraminotomy/Herniated Diskectomy; Re-Exploration, Lumbar
63056 / Transpedicular Approach, 1 Segment; Lumbar (Transfacet/Lateral Extraforaminal)
Lumbar Laminectomy
22102 / Partial Excision, Posterior Vertebral Component, Single; Lumbar
63005 / Laminectomy w/o Facetectomy/Foraminotomy/Diskectomy, 1 to 2 Segments; Lumbar
63012 / Laminectomy w/Removal of Abnormal Facets, etc for spondylolisthesis; Lumbar
63017 / Laminectomy w/o Facetectomy/Foraminotomy/Diskectomy, 2 Segments; Lumbar
63047 / Laminectomy, Facetectomy & Foraminotomy, 1 Segment; Lumbar
63200 / Laminectomy, w/Release, Tethered Spinal Cord, Lumbar
63267 / Laminectomy, Excision, Non-neoplastic Lesion, Extradural; Lumbar
63272 / Laminectomy, Excision, Intraspinal Lesion Other than Neoplasm, Intradural; Lumbar
Lumbar Spinal Fusion Without Mention of Hardware
22558 / Arthrodesis, Anterior Interbody,; Lumbar
22612 / Arthrodesis, Posterior/Posterolateral, Single Level; Lumbar
22625 / Lumbar Spine Fusion
22630 / Arthrodesis, Posterior Interbody, w/Laminectomy/Diskectomy, Single Interspace; Lumbar
22650 / Lumbar Spine Fusion, Extra (addtl) Segment (was replaced by 22614)
Appendix Table 4: Back-specific ICD-9-CM procedure codes (which do not specify lumbar spine). A case with a procedure code from this Table is selected as “definite” if there is also a diagnosis from Table 6. A case with a procedure code from this Table is selected as “possible” if there is also a diagnosis from Table 7 or from Table 8. However, as code 78.69 is not specific to the spine, a definite or possible case must also have a procedure code other than 78.69 in order to be included. If a case with a procedure code from Table 4 has no diagnosis from Table 6, 7, or 8, the case is not selected. If there is no procedure code from Table 4 (other than 78.69) and no procedure code from Table 5 AND a diagnosis code from Table 8 (but none from Table 6 or 7), the case is not selected.
Procedure Code /
Description
Laminectomy
03.0 / Exploration and decompression of spinal canal structures
03.09 / Other exploration and decompression of spinal canal
Diskectomy
80.5 / Excision or destruction of intervertebral disc
80.50 / Excision or destruction of intervertebral disc unspecified
80.51 / Excision of intervertebral disc
80.52 / Intervertebral chemonucleolysis
80.59 / Other destruction of intervertebral disc
Fusion
81.00 / Spinal fusion, not otherwise specified
81.05 / Dorsal/dorsolumbar fusion, posterior technique
81.09 / Other spinal fusion (Not Elsewhere Classified)
Removal of hardware
78.69 / Removal of internal fixation device (vertebral, pelvic, or phalangeal)
Other
03.02 / Reopening of laminectomy site
03.6 / Lysis of adhesions of cord or nerve root
Appendix Table 5: Back-specific CPT-4 codes. A case with a code from this Table is selected as “definite” if there is also a diagnosis from Table 6. A case with a code from this Table is selected as “possible” if there is also a diagnosis from Table 7 or 8. If there is no diagnosis code from Table 6, 7 or 8, the case is not selected.
Spinal Fusion Modifications
20930 / Allograft, Spine Surgery Only; Morselized (not specifically lumbar)
20931 / Allograft, Spine Surgery Only; Structural (not specifically lumbar)
20937 / Autograft, Spine Surgery; Morselized, Separate Incision (not specifically lumbar)
20938 / Autograft, Spine Surgery; Structural, Bicortical/Tricortical, Separate Incision (not specifically lumbar)
22585 / Arthrodesis, Each Additional Anterior Interspace (not specifically lumbar)
22614 / Arthrodesis, Posterior/Posterolateral, Single Level; Add'l Segment
22632 / Arthrodesis, Posterior Interbody, Single Interspace; Add'l Interspace
Fusion Plus Hardware (not specifically lumbar)
22841 / Int Spinal Fixation, Wiring, Spinous Processes
22842 / Posterior Segmental Instrumentation: 3-6 Vertebral Segments
22843 / Posterior Segmental Instrumentation: 7-12 Vertebral Segments
22844 / Posterior Segmental Instrumentation: 13+ Vertebral Segments
22845 / Anterior Instrumentation: 2 to 3 Vertebral Segments
22846 / Anterior Instrumentation: 4 to 7 Vertebral Segments
22847 / Anterior Instrumentation: 8+ Vertebral Segments
22849 / Reinsertion, Spinal Fixation Device
22851 / Application of Intervertebral Biomechanical Device
Diskectomy (not specifically lumbar)
63035 / Laminotomy w/Partial Facetectomy/Foraminotomy/Herniated Diskectomy, Add'l Interspace, Cervical/Lumbar
63057 / Transpedicular Approach, Add'l Segment, Thoracic/Lumbar (Transfacet/Lateral Extraforaminal)
Laminectomy (not specifically lumbar)
63048 / Laminectomy, Facetectomy & Foraminotomy; Add'l Segment, Cervical/Thoracic/Lumbar
Removal of Hardware (not specifically lumbar)
22850 / Removal, Posterior Nonsegmental Instrumentation (not specifically lumbar)
22852 / Removal, Posterior Segmental Instrumentation (not specifically lumbar)
22855 / Removal, Anterior Instrumentation (not specifically lumbar)
Other (not specifically lumbar)
22830 / Exploration of spinal fusion (not specifically lumbar)
28999 / Spine Surgery procedure (not specifically lumbar)
63707 / Repair spinal fluid leakage
63709 / Repair spinal fluid leakage
63710 / Graft repair of spine defect
Appendix Table 6: Diagnosis codes for “definite” low back surgery A case with any diagnoses in Table 2 and any procedure code in Table 4 or 5 is selected as “definite”.
Diagnosis Code / Description
Herniated Disc
722.10 / Displacement of lumbar disc
722.73 / Herniated lumbar disc with myelopathy
Disc Degeneration
721.3 / Lumbrosacral spondylosis, no myelopathy
722.52 / Degeneration of lumbar disc
722.93 / Lumbar disc displacement NOS
Spinal Stenosis
721.42 / Spondylogenic compression of lumbar spinal cord
724.02 / Lumbar stenosis
Possible Instability
724.6 / Disorders of sacrum: includes instability of lumbrosacral joint
738.4 / Acquired spondylolisthesis (included because these are overwhelmingly lumbar)
756.11 / Spondylolysis, lumbar
756.12 / Spondylolisthesis (included because these are overwhelmingly lumbar)
Miscellaneous low back problems
353.4 / Lumbrosacral root lesions
355.0 / Sciatic nerve lesion
722.83 / Postlaminectomy syndrome, lumbar
724.2 / Lumbago
724.3 / Sciatica
739.3 / Non-allopathic lesions, lumbar spine
739.4 / Non-allopathic lesions, sacral region
846.0-846.9 / Sprains and strains, lumbosacral and other sacral ligaments
847.2 / Sprains and strains, lumbar
847.3 / Sprains and strains, sacral
Appendix Table 7: Diagnosis codes for “possible” low back surgery A case with any diagnosis code in Table 7 and any procedure code (including 78.69) in Table 4 or 5 (but no procedure code in Table 2) is selected as “possible”
Diagnosis Code / Description
353.8 / Nerve root/plexus disease NEC
721.5 / Kissing spine
721.0-721.91 / Spondylosis, unspecified site
722.10-722.19 / Displacement of thoracic or lumbar intervertebral disc without myelopathy
722.2 / Herniated disc, unspecified site
722.6 / Degeneration intervertebral disc, unspecified site
722.70 / Intervertebral disc disorder with myelopathy, site unspecified
722.80 / Post-laminectomy syndrome, unspecified region
722.90 / Other and unspecified disc disorder, unspecified region
724.00 / Stenosis, unspecified site, not cervical
724.09 / Stenosis, other, not cervical
724.4 / Thoracic or lumbrosacral neuritis or radiculitis
724.5 / Backache, unspecified
724.8 / Other symptoms referable to back
724.9 / Other unspecified back disorders
847.9 / Sprain and strain, unspecified part of back
Appendix Table 8. Diagnosis codes for “possible” low back surgery when there is a procedure code from Table 4 (other than 78.69) or from Table 5 A case with any procedure code other than 78.69 in Table 4 or any procedure code in Table 5, and any diagnosis code in Table 8 (but no diagnosis code in Table 6 or Table 7), is selected as “possible”. If there is no procedure code in Table 4 other than 78.69, and no procedure code in Table 5, and a diagnosis code in Table 8 but not in Table 6 or 7, the case is not selected.
Diagnosis Code / Description
729.2 / Neuralgia/neuritis NOS
996.4 / Mechanical complication of orthopædic device
996.70 / Complications of internal prosthetic device
996.75 / Complications of nervous system device/graft
996.78 / Complications of other internal orthopædic device
996.79 / Complications of internal prosthetic device NEC
E878.1 / Abnormal reaction to implant
E878.8 / Abnormal reaction to surgical procedure
V45.4 / Arthrodesis status
V53.09 / Adjust nervous system device
V54.0 / Removal of internal fixation device
V54.8 / Orthopædic aftercare NEC
Appendix Figure: Flow chart showing case selection algorithm