Validation of an electronic coding algorithm to identify the primary indication of orthopedic surgeries from administrative data

Abstract

Background Determining the primary indication of a surgical procedure can be useful in identifying patients undergoing elective surgery where shared decision-making is recommended. The purpose of this study was to develop and validate an algorithm to identify patients receiving the following combinations of surgical procedure and primary indication as part of a study to promote shared decision-making: (1) knee arthroplasty to treat knee osteoarthritis (KOA); (2) hip arthroplasty to treat hip osteoarthritis (HOA); (3) spinal surgery to treat lumbar spinal stenosis (SpS); and (4) spinal surgery to treat lumbar herniated disc (HD). Methods Consecutive surgical procedures performed by participating spine, hip, and knee surgeons at four sites within an integrated care network were included. Study staff reviewed electronic medical records to ascertain a “gold standard” determination of the procedure and primary indication status. Electronic algorithms consisting of ICD-10 and CPT codes for each combination of procedure and indication were then applied to records for each case. The primary measures of validity for the algorithms were the sensitivity and specificity relative to the gold standard review. Results Participating surgeons performed 790 procedures included in this study. The sensitivity of the algorithms in determining whether a surgical case represented one of the combinations of procedure and primary indication ranged from 0.70 (HD) to 0.92 (KOA). The specificity ranged from 0.94 (SpS) to 0.99 (HOA, KOA). Conclusion The electronic algorithm was able to identify all four procedure/primary indication combinations of interest with high specificity. Additionally, the sensitivity for the KOA cases was reasonably high. For HOA and the spine conditions, additional work is needed to improve the sensitivity of the algorithm to identify the primary indication for each case.

Association between chiropractic spinal manipulation and lumbar discectomy in adults with lumbar disc herniation and radiculopathy: retrospective cohort study using United States’ data

“…Patients with serious spine pathology or absolute indication for surgery, such as CES, signs of CES such as bowel or bladder incontinence, fracture, infection and malignant neoplasms were excluded over 365 days preceding and including the date of index diagnosis (online supplemental table 2). 39 Patients with conditions that could alter the CSMT or surgical approach and/or increase the odds of lumbar surgery were also excluded: lumbar fusion, arthrodesis or post-laminectomy syndrome,40 41 lumbar spine trauma42 and degenerative lumbar scoliosis and spondylolisthesis 43. As an additional measure of ensuring patients had no previous discectomy, we excluded patients with any instance of discectomy occurring over any time available in the dataset preceding and including the index date of diagnosis.…”

“…A definition for the outcome of lumbar discectomy was developed based on discussion among coauthors and comparison with previous publications (online supplemental table 4). 36 39 46 47 This definition included multiple procedure codes for discectomy, as well as the ICD-10-PCS code 0SB4* which includes open, percutaneous and percutaneous endoscopic approaches to excise lumbosacral disc material,48 and the Healthcare Common Procedure Coding System code C9757 for lumbar discectomy with implantation of an annular closure device 47. Feasibility testing was conducted in June, 2021, to ensure these codes were represented in the TriNetX database.…”

Comparison of readmission and complication rates between traditional sleep surgery and hypoglossal nerve stimulation

“…CPT and ICD‐10 have high consistency and using both code sets has been shown to increase the sensitivity of procedural case identification. 26 Since HNS was a new surgical option, we decided to compare it to the most commonly performed sleep surgeries prior to HNS, which were palate and multi‐level surgeries. 27 The three cohorts were patients who underwent palate surgery (palate cohort) those who underwent palate and tongue base surgery (multilevel cohort), and patients who received an HNS device (HNS cohort).…”

“…The usage of both CPT (HCPCS Level I) and ICD‐10‐PCS procedure codes was chosen as a best practice to comprehensively capture procedures when physician or facility billing were in different systems. CPT and ICD‐10 have high consistency and using both code sets has been shown to increase the sensitivity of procedural case identification 26 . Since HNS was a new surgical option, we decided to compare it to the most commonly performed sleep surgeries prior to HNS, which were palate and multi‐level surgeries 27 .…”

Assessing the quality of shared decision making for elective orthopedic surgery across a large healthcare system: cross-sectional survey study

“…The time window was set to survey patients outside the immediate recovery period, but not too long after the procedure. Study staff identified patients using a validated algorithm to search electronic health records for relevant ICD and CPT codes, and confirmed eligibility with a limited chart review [ 13 ]. Eligible patients who had undergone TJR were then randomly selected to be included in the study, stratified by surgeon, site, and condition to match the sample size target described in the “Statistical Analyses” subsection below; all eligible patients who had undergone spine surgery were selected for inclusion in the study because of the relatively smaller size of those groups.…”