Table 1.
Claims-based classification of patients with spine-related medical encounters into clinically meaningful diagnosis and spinal region groups based on codes from the International Classification of Diseases, 9th revisions, Clinical Modification and Current Procedural Terminology Codes (CPT).
| GROUP | CATEGORY | VARIABLE NAME | CODING | CODES | |
|---|---|---|---|---|---|
| Diagnosis | Degenerative (subcategories are ordered in a mutually-exclusive hierarchy from least to most specific pathology) | Sprains/strains | DEGDX=1 (Hierarchy); SPINEDX1 | DEGDX = 1; 0 = No; 1 = Yes |
ICD-9 Diagnosis codes 846.0 846.1 846.2 846.3 846.8 846.9 847 847.9 847.2 847.0 |
| Back pain (axial pain and spondylosis) | DEGDX=2 (Hierarchy); SPINEDX2 | DEGDX = 2; 0 = No; 1 = Yes |
ICD-9 Diagnosis codes 723 723.8 723.1 721.0 721.1 721.2 721.3 721.4721.7 721.8 721.9 721.90 721.91 722.4 722.5722.51 722.52 722.6 722.90 722.92 722.91 722.93 724.2 724.5 724.6 724.70 724.71 724.79 724.8 724.9 |
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| Herniated without myelopathy | DEGDX=3 (Hierarchy); SPINEDX3 | DEGDX = 3; 0 = No; 1 = Yes |
ICD-9 Diagnosis codes 722.0 722.10 722.11 722.2 |
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| Herniated with myelopathy | DEGDX=4 (Hierarchy); SPINEDX4 | DEGDX = 4; 0 = No; 1 = Yes |
ICD-9 Diagnosis codes 353.9 355.0 355.9 722.70 722.71 722.72 722.73 724.3 721.4 724.4 |
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| Stenosis | DEGDX=5 (Hierarchy); SPINEDX5 | DEGDX = 5; 0 = No; 1 = Yes |
ICD-9 Diagnosis codes 721.42 721.91 724.00 724.02 724.09 723.0 724.01 |
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| Listhesis | DEGDX=6 (Hierarchy); SPINEDX6 | DEGDX = 6; 0 = No; 1 = Yes |
ICD-9 Diagnosis codes 738.4 756.11 756.12 |
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| Scoliosis | DEGDX=7 (Hierarchy); SPINEDX7 | DEGDX = 7; 0 = No; 1 = Yes |
ICD-9 Diagnosis codes 737.39 737.3 737.30 737 737.20 737.8 737.9 737.1 737.10 737.19 737.32 737.34 737.43 |
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| Spinal fracture or dislocation | SPINEDX8 | 0 = No; 1 = Yes |
ICD-9 Diagnosis codes 733.1 733.10 733.13 733.8 733.81 733.82 733.95 805 805.0 805.00 805.01 805.02 805.03805.04 805.05 805.06 805.07 805.08 805.1 805.10 805.11 805.12 805.13 805.14 805.15 805.16 805.17 805.18 805.2 805.3 805.4805.5 805.6 805.7 805.8 805.9 806 806.0 806.00 806.01 806.02 806.03 806.04 806.05806.06 806.07 806.08 806.09 806.1 806.10 806.11 806.12 806.13 806.14 806.15 806.16 806.17 806.18 806.19 806.2 806.20 806.21 806.22 806.23 806.24 806.25 806.26 806.27 806.28 806.29 806.3 806.30 806.31 806.32 806.33 806.34 806.35 806.36 806.37 806.38 806.39 806.4 806.5 806.6 806.60 806.61 806.62 806.69 806.7 806.70 806.71 806.72 806.79 806.8 806.9 839.0 839.00 839.01 839.02 839.03 839.04 839.05 839.06 839.07 839.08 839.1 839.10 839.11 839.12 839.13 839.14 839.15 839.16 839.17 839.18 839.2 839.20 839.21 839.3 839.30 905.1 V54.17 V54.27 |
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| Spinal Cord Injury | SPINEDX9 | 0 = No; 1 = Yes |
ICD-9 Diagnosis codes 336.9952.0 952.00 952.03 952.05 952.09 952.10952.9 953.0 952.04 |
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| Congenital or other spinal anomaly | SPINEDX10 | 0 = No; 1 = Yes |
ICD-9 Diagnosis codes 324.1 344.60 721.5 721.6 721.7 722.30 722.32 723.7 724.6 727.40 733.20 738.5 739.3 739.4 741.90 754.2 756.10 756.13 756.14 756.15 756.16 756.17 756.19 |
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| Inflammatory spondylopathy | SPINEDX11 | 0 = No; 1 = Yes |
ICD-9 Diagnosis codes 720.0 720.1 720.2 720.8 720.81 720.89 720.9 |
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| Osteoporosis | SPINEDX12 | 0 = No; 1 = Yes |
ICD-9 Diagnosis codes 733.0 733.00 733.01 733.02 733.03 733.09 V17.81 V82.81 |
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| Surgical aftercare/ revision / previous surgery (Spine related codes that imply previous spine procedure) | SPINEDX13 | 0 = No; 1 = Yes |
CPT codes 0098T 0165T 22861 22862 62350 62351 63660 63688 64585 64595 11982 11983 20665 20670 20680 22850 22852 22855 22864 22865 62355 62365 63660 63688 64585 64595 ICD-9 Diagnosis codes 722.80 722.81 722.83 874.9 996.67 E878.1 996.2 996.59 996.4 996.40 996.41 996.49 998.59 V45.4 996.78 ICD-9 Procedure codes 81.09 81.30 81.31 81.32 81.33 81.34 81.35 81.36 81.37 81.38 81.39 03.94 03.97 03.98 78.6 78.60 78.69 84.81 03.02 84.83 84.85 84.66 84.67 84.68 84.69 |
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| Region | Atlas/Axis | REG_A | 0 = No; 1 = Yes |
CPT codes 22318 22319 22548 22590 22595 ICD-9 Diagnosis Codes 805.01 805.02 805.11 805.12 839.01 839.02 839.11 839.12 ICD-9 Procedure Codes 81.01 81.31 |
|
| Cervical | REG_C | 0 = No; 1 = Yes |
CPT Codes 0092T 63300 63304 22856 22861 22864 63001 63015 63051 63075 63076 63081 63082 63180 63182 63265 63270 63275 0095T 0098T 20660 20661 20664 20665 21899 22100 22110 22210 22220 22326 22554 22600 63040 63043 63045 63194 63196 63198 63250 63280 63285 72040 72050 72052 72126 72127 72141 72142 72147 72156 72125 63020 63050 ICD-9 Diagnosis Codes 847.0 721.0 721.1 722.4 722.91 723* 723.1 723.8 722.0 722.71 723.0 722.81 805.0 805.00805.03 805.04 805.05 805.06 805.07 805.08 805.1 805.10 805.13 805.14 805.15 805.16 805.17 805.18 806.0 806.00 806.01 806.02806.03 806.04 806.05 806.06 806.07 806.08806.09 806.1 806.10 806.11 806.12 806.13 806.14 806.15 806.16806.17 806.18 806.19 839.0 839.00 839.03839.04 839.05 839.06 839.07 839.08 839.1839.10 839.13 839.14 839.15 839.16 839.17839.18 952.0 952.00 952.00 952.03 952.09953.0 723.7 952.04 ICD-9 Procedure Codes 93.52 93.41 87.22 81.02 81.03 81.32 81.33 84.61 84.62 84.66 |
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| Cervico-thoracic | REG_CT | 0 = No; 1 = Yes |
CPT Codes 64470 64470 64470 64470 64472 64479 64480 92291 22010 62281 62310 62318 72285 64491 64493 ICD-9 Procedure Codes 87.23 84.63 84.67 |
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| Thoracic | REG_T | 0 = No; 1 = Yes |
CPT codes 63085 63086 63197 63199 63266 63271 63276 63286 63287 63077 63078 63016 63055 63066 20250 63003 22101 22112 22141 22206 22212 22222 22327 22520 22523 22532 22556 22610 63046 63064 63195 63251 63281 63301 63305 72070 72072 72074 72128 72129 72130 72132 72146 72157 ICD-9 Diagnosis Codes 721.2 722.51 722.92 722.11 722.72 724.01 737.34 805.2 805.3 806.2 806.20 806.21 806.22 806.23 806.24 806.25 806.26 806.27 806.28 806.29 839.21 952.10 806.3 806.30 806.31 806.32 806.33 806.34 806.35 806.36 806.37 806.38 806.39 862.8 862.8 ICD-9 Procedure Codes 81.04 81.05 81.34 81.35 |
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| Thoracolumbar | REG_TL | 0 = No; 1 = Yes |
CPT codes 22522 22525 22534 63057 63087 63088 63103 63252 63302 63306 64520 72069 72080 ICD-9 Diagnosis Codes 721.4 722.5 839.2 839.3 |
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| Lumbar | REG_L | 0 = No; 1 = Yes |
CPT Codes 63042 63044 63047 63056 63200 63267 63272 63277 63017 63030 63005 62287 22865 22862 22625 22630 22612 22533 22524 22521 0163T 0164T 0165T 22102 22114 22207 22214 22224 22325 22558 62290 62292 63012 63282 64714 72131 72133 72148 72149 72158 72295 0171T 0172T 72295 ICD-9 Diagnosis codes 722.93 724.2 721.42 722.10 722.73 724.02 722.83 805.4 805.5 806.4 806.5 839.20 739.3 839.30 847.2 |
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| Lumbosacral | REG_LS | 0 = No; 1 = Yes |
CPT Codes 22015 62311 62319 63303 63307 64475 64476 64483 64484 64622 64623 72100 72110 72114 72120 62311 64494 94495 ICD-9 Diagnosis codes 846.0 721.3 722.52 724.4 756.11 846.0 ICD-9 Procedure codes 84.64 84.65 84.68 87.24 81.06 81.07 81.08 81.36 81.37 81.38 |
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| Sacral | REG_S | 0 = No; 1 = Yes |
CPT Codes 63278 63283 63268 63273 27096 62282 63011 63283 72200 72202 72220 ICD-9 Diagnosis codes 846.1 846.3 846.8 846.9 724.6 724.70 724.71724.79 805.6 805.7 806.6 806.60 806.61 806.62 806.69 806.7 806.70 806.71 806.72806.79 739.4 |
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