Procedural coding of spinal surgeries (CPT-4 versus ICD-9-CM) and decisions regarding standards: a multicenter study.
METHODS
A comparison of procedural coding systems ( [ICD-9-CM] [CPT-4]) applied to lumbar spine surgery patients from six teaching institutions.


OBJECTIVE
To compare the detail reflected by coding systems used to describe spinal procedures.


BACKGROUND
Administrative databases contain ICD-9-CM procedural codes, which are derived from hospital discharge abstracts. These databases are used, in part, to establish health care utilization patterns and set health care policy. Previous studies have demonstrated inaccuracies in ICD diagnosis coding. However, the literature is void of information regarding the accuracy of ICD procedural coding of spine procedures.


METHODS
Data were complete in 143 of 150 lumbar spine surgery patients (aged 17-84 years). Surgeons assigned CPT-4 procedural codes. These codes were compared with ICD procedure codes assigned by hospital medical records staff.


RESULTS
On average, in four of six hospitals, there were more CPT codes assigned to patient records by the surgeon than ICD codes assigned by hospital medical records staff. Overall, CPT codes reflected a greater level of detail than ICD codes.


CONCLUSIONS
These findings illustrate the increased detail of CPT coding over ICD coding in the spinal surgery cases reviewed. The ICD procedural codes contained in administrative databases tend to underrepresent the complexity of the surgical procedures actually performed.
Faciszewski
Tom
T
Department of Orthopaedic Spine Surgery, Marshfield Clinic, Marshfield, Wisconsin 54449, USA. faciszet@mfldclin.edu
Jensen
Ron
R
Berg
Richard L
RL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery; D008499:Medical Records / Q000145:classification / Q000592:standards*; D008510:Medication Systems, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000145:classification* / Q000706:statistics & numerical data; D010564:Personnel, Hospital / Q000592:standards / Q000706:statistics & numerical data