Background
Rationale
Methods
Sample and data sources
Automated algorithm
Inclusion CPT Codes | Inclusion ICD-10 Codes (Require one or more three months prior to surgery) | Exclusion ICD-10 Codes (Three Months Prior to Surgery) |
---|---|---|
A: Spinal Surgery for Lumbar Spinal Stenosis | ||
22224, 22533, 22558, 22586, 22612, 22614, 22630, 22632, 22633, 22800, 22802, 22804, 22808, 22810, 22857, 22862, 22867, 63005, 63011, 63012, 63017, 63047, 63048, 63056, 63087, 63088, 63090, 63091, 63102, 63103, 63170 | M48.00, M48.061, M48.062, M48.07, M48.08 | G83.4, R15*, S32.0*, N31*, C41.2, M48.56*, M84.58*, R32, M48.46*, M84.48*, M84.40*, M84.60*, M48.57*, S22.08* |
B: Spinal Surgery for Lumbar Herniated Disc | ||
22224, 22533, 22558, 22586, 22612, 22614, 22630, 22632, 22633, 22800, 22802, 22804, 22808, 22810, 22857, 22862, 22867, 62287, 63005, 63011, 63012, 63017, 63030, 63035, 63042, 63047, 63048, 63056, 63087, 63088, 63090, 63091, 63102, 63103, 63170 | M51.06, M51.16, M51.17, M51.26, M51.27, M51.36, M51.37, M47.16, M47.26, M47.27 | G83.4, R15*, S32.0*, N31*, C41.2, M48.56*, M84.58*, R32, M48.46*, M84.48*, M84.40*, M84.60*, M48.57*, S22.08* |
C: Hip Arthroplasty for Hip Osteoarthritis | ||
27125, 27130, 27132 | M16.0, M16.10, M16.11, M16.12, M16.2, M16.30, M16.31, M16.32, M16.4, M16.50, M16.51, M16.52, M16.6, M16.7, M16.9 | M84.459*, M84.559*, S72.0*, S32.4*, M87*, M80*, M84.359*, M84.58*, S72.1*, S72.2*, C79.51, M84.30*, M84.40*, M84.48*, M84.50*, C41.4, C41.9 |
D: Knee Arthroplasty for Knee Osteoarthritis | ||
27438, 27440, 27441, 27442, 27443, 27445, 27446, 27447 | M17.0, M17.10, M17.11, M17.12, M17.2, M17.30, M17.31, M17.32, M17.4, M17.5, M17.9 | M80*, M87*, C79.51, C41.9 |
Algorithm development
“Gold standard” chart review
Analysis
Results
Hip Arthroplasty/Hip OA | Knee Arthroplasty/Knee OA | Lumbar Spinal Surgery/Lumbar Spinal Stenosis | Lumbar Spinal Surgery/Lumbar Herniated Disc | Other Indication | |
---|---|---|---|---|---|
Number of Surgeries | 134 | 119 | 131 | 54 | 352 |
Average Age (Years) | 62.5 | 67.3 | 66.9 | 52.5 | 58.3 |
Gender (Percent Female) | 49.3% | 62.2% | 52.7% | 53.7% | 50.3% |
Condition was Primary Indication (%) | 128 (95.5%) | 115 (96.6%) | 127 (96.9%) | 53 (98.1%) | NAa |
Surgery Location | Number of Procedures (%) |
---|---|
Ankle/Foot | 17 (5%) |
Arm/Hand | 32 (9%) |
Cervical Spine | 71 (20%) |
Femur | 38 (11%) |
Hip | 50 (14%) |
Knee | 70 (20%) |
Lumbar Spinea | 52 (15%) |
Thoracic Spine | 22 (6%) |
Procedure/Indication | Sensitivity (95% Confidence Interval) | Specificity (95% Confidence Interval) |
---|---|---|
Lumbar Spinal Surgery/Lumbar Herniated Disc | 0.96 (0.87, 1.00) | 0.74 (0.69, 0.79) |
Lumbar Spinal Surgery/Lumbar Spinal Stenosis | 0.91 (0.85, 0.95) | 0.82 (0.77, 0.87) |
Knee Arthroplasty/Knee Osteoarthritis | 0.97 (0.92, 0.99) | 0.84 (0.80, 0.88) |
Hip Arthroplasty/Hip Osteoarthritis | 0.99 (0.96, 1.00) | 0.87 (0.83, 0.91) |
Procedure/Primary Indication | Sensitivity (95% Confidence Interval) | Specificity (95% Confidence Interval) |
---|---|---|
Lumbar Spinal Surgery/Lumbar Herniated Disc | 0.70 (0.56, 0.82) | 0.96 (0.94, 0.98) |
Lumbar Spinal Surgery/Lumbar Spinal Stenosis | 0.76 (0.68, 0.83) | 0.94 (0.91, 0.97) |
Knee Arthroplasty/Knee Osteoarthritis | 0.92 (0.86, 0.96) | 0.99 (0.98, 1.00) |
Hip Arthroplasty/Hip Osteoarthritis | 0.84 (0.76, 0.90) | 0.99 (0.98, 1.00) |
Diagnosis | Misclassification | Reasons |
---|---|---|
Lumbar Herniated Disc (n = 29) | False Positive (n = 13) | Spinal Stenosis Case (n = 8) Severe Incontinence Diagnosis (n = 1) Cervical or Thoracic Spine Case (n = 1) Flatback Syndrome Case (n = 1) Spondylolisthesis Case (n = 1) Revision Discectomy Case (n = 1) |
False Negative (n = 16) | Incorrectly Classified as Spinal Stenosis (n = 9) Procedure Billing Codes not included in Data (n = 4) Incorrectly Marked as Non-Primary Indication because of urinary incontinence diagnosis (n = 2) Incorrectly Marked as Non-Primary Indication because of cauda equina diagnosis (n = 1) | |
Lumbar Spinal Stenosis (n = 46) | False Positive (n = 16) | Herniated Disc Case (n = 9) Cervical or Thoracic Spine Case (n = 4) Infection Present (n = 1) Flatback Syndrome Case (n = 1) Epidural Abscess Case (n = 1) |
False Negative (n = 30) | Procedure Billing Codes not included in Data (n = 11) Incorrectly Classified as Herniated Disc (n = 8) CPT code (63046, 63267) not included in algorithm (n = 6) Incorrectly Marked as Non-Primary Indication because of collapsed vertebra diagnosis (n = 2) Incorrectly Marked as Non-Primary Indication because of fecal incontinence diagnosis (n = 1) Incorrectly Marked as Non-Primary Indication because of fracture diagnosis (n = 1) Incorrectly marked as Non-Primary Indication because of bladder dysfunction diagnosis (n = 1) | |
Knee Osteoarthritis (n = 11) | False Positive (n = 2) | Procedure was actually to revise previous knee replacement (n = 1) Rheumatoid Arthritis Case (n = 1) |
False Negative (n = 9) | Procedure Billing Codes not included in Data (n = 6) CPT code (27486, 27487) not included in algorithm (n = 2) Incorrectly Marked as Non-Primary Indication because of osteonecrosis diagnosis (n = 1) | |
Hip Osteoarthritis (n = 23) | False Positive (n = 2) | Osteonecrosis Diagnosis (n = 1) Developmental Hip Dysplasia Case (n = 1) |
False Negative (n = 21) | Incorrectly Marked as Non-Primary Indication because of osteonecrosis diagnosis (n = 12) Procedure Billing Codes not included in Data (n = 6) CPT code (27134) not included in algorithm (n = 1) Incorrectly Marked as Non-Primary Indication because of fracture diagnosis (n = 1) Incorrectly Marked as Non-Primary Indication because of neoplasm diagnosis (n = 1) |