Discrepancies Exist Between Administrative Database Codes and Surgeons’ Diagnoses for Lumbar Spinal Fusion Surgeries
Embargo expired: 8-Apr-2014 8:20 PM EDT
Source Newsroom: American Association of Neurological Surgeons (AANS)
SAN FRANCISCO (April 8, 2014) — Recent statistics taken from national administrative databases suggest that lumbar spinal fusion is on the rise, with the greatest increases occurring among patients with herniated discs or degenerative disc disease. Yet, surgeons claim neither condition is a well-accepted indication for such surgery. How accurately, then, do such databases capture the surgeon’s indication for fusion?
A research team led by Yakov Gologorsky, MD, focused on statistics in the Nationwide Inpatient Sample (NIS), which classifies cases using ICD-9-CM discharge codes—codes assigned by hospital medical coders rather than by surgeons. In The Nationwide Inpatient Sample Database Does Not Accurately Reflect Surgical Indications for Fusion, the team reported significant discrepancies between discharge codes and surgeons’ own diagnoses. Dr. Gologorsky presented the team’s findings today during the 82nd Annual Scientific Meeting of the American Association of Neurological Surgeons (AANS).
Researchers reviewed 170 lumbar fusions undertaken across a two-year period, comparing surgeons’ diagnoses with the primary ICD-9-CM code submitted to the NIS. In 59 percent of those cases, the primary ICD-9-CM diagnosis matched the surgeon’s diagnosis. Of those 170 admissions that led to surgeries, 43 involved well-accepted indications of trauma, tumor, or infection; the remaining 127 were for degenerative diseases. Excluding the 43 surgeries whose indications were well-accepted, the team found the primary ICD-9-CM diagnosis matched the surgeon’s diagnosis only 45 percent of the time.
The team found that characterizing the indications for this surgery based on ICD-9-CM codes extracted from administrative databases does not accurately reflect the surgeon’s indication. While such databases may accurately describe national rates of lumbar fusion surgery, the lack of fidelity in the source codes limits their ability to accurately identify indications for surgery.
The study’s co-authors include John Knightly, MD, FAANS; John Chi, MD, MPH, FAANS; and Michael W. Groff, MD, FAANS.
Disclosure: The author reported no conflicts of interest.
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Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with nearly 8,600 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons (Neurosurgery) of Canada or the Mexican Council of Neurological Surgery, AC. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system including the spinal column, spinal cord, brain and peripheral nerves. For more information, visit www.AANS.org.