Discrepancies Exist Between Administrative Database Codes and Surgeons’ Diagnoses for Lumbar Spinal Fusion Surgeries

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.Media Representatives: The 2014 AANS Annual Meeting Press Kit includes releases on highlighted scientific research, AANS officer and award winners, National Neurosurgery Awareness Week, and other relevant information about this year’s program. Those releases also will be posted under the Media area on the 2014 AANS Annual Scientific Meeting website (http://www.aans.org/Annual Meeting/2014/Main/Media.aspx). If you would have interest in a topic related to neurosurgery or would like to interview a neurosurgeon — either onsite or via telephone — during this year’s event, please contact John Iwanski, AANS Director of Integrated Marketing and Website Communications, via the onsite press room at 415.978.3603 or e-mail him at [email protected].

About the 2014 AANS Annual Scientific Meeting: Attended by neurosurgeons, neurosurgical residents, medical students, neuroscience nurses, clinical specialists, physician assistants, allied health professionals and other medical professionals, the AANS Annual Scientific Meeting is the largest gathering of neurosurgeons in the nation, with an emphasis on the field’s latest research and technological advances. A record-breaking 1,321 scientific abstracts were presented for review at the 2014 AANS Annual Scientific Meeting, and the scientific presentations given at this year’s event represent cutting-edge examples of the incredible developments taking place within the field of neurosurgery. Additional information about the AANS Annual Scientific Meeting and the Meeting Program can be found at http://www.aans.org/Annual Meeting/2014/Main/Home.aspx.

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.

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