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Discrepancies seen in surgeon and discharge codes for lumbar spine fusions
Discharge codes for fusion can differ. Researchers reported in a study that was the case more than 50% of the time.
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SAN FRANCISCO — In a study presented at the American Association of Neurological Surgeons Annual Meeting, here, investigators reported statistics taken from national administrative databases suggest lumbar spine fusion is on the increase, with the greatest increases occurring among patients with herniated discs or degenerative disc disease.
However, surgeons claim that neither herniated disc nor degenerative disc disease is an indication for lumbar fusion, and many of the databases inaccurately record the surgeon’s reasoning for performing fusion.
A national comparison
For the investigation, Yakov Gologorsky, MD, of Boson, who presented the findings, and colleagues studied recent statistics in the Nationwide Inpatient Sample (NIS) that classify cases using ICD-9-CM discharge codes assigned by hospital medical coders rather than surgeons. They reviewed 170 lumbar fusions performed in a 2-year period and compared the surgeons’ diagnoses with the primary ICD-9-CM code submitted to the NIS.
Gologorsky said the codes are not generated by physicians, but trained medical coders. In general, trained medical coders look at the medical records, including operative reports, office notes, progress notes, and they look at reports of radiology. They look at the information available to them and try to assign codes for a diagnosis procedure. For each case, they will assign one primary code and up to 19 secondary codes for each hospitalization, he noted.
The investigators looked at the entire medical record for each operation and identified the indication for fusion either as spondylolisthesis, deformity, tumor, infection, trauma, pseudarthrosis, adjacent-level degeneration, stenosis, or degenerative disc pathology or disc herniation. They then compared their diagnoses with those generated by the medical coders.
Significantly different diagnosis
The researchers found the primary ICD-9-CM diagnosis matched the surgeon’s diagnosis only 45% of the time.
“We have shown that the primary indication, especially in degenerative cases, is wrong in more than 50% of the cases. It certainly calls into question the force of the conclusions reached by some researchers who mine large administrative databases in an effort to study trends in spinal fusion surgery stratified solely by primary diagnoses,” Gologorsky told Spine Surgery Today.
Furthermore, Gologorsky and colleagues reported that characterizing the hospital-based indications for this surgery as reflected in ICD-9-CM codes extracted from administrative databases does not accurately reflect the surgeon’s indication for lumbar spine fusion.
“Even when all diagnosis codes were considered, the medical coder did not identify surgical indication for fusion in 20% of the cases, when in fact it was actually documented in the medical record clearly,” Gologorsky said. – by Robert Linnehan
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Disclosure: Gologorsky has no relevant financial disclosures.