Report 1 ICD-9-CM PROCEDURE CODES

Transcription

1 Report 1 ICD-9-CM PROCEDURE CODES ICD-9-CM procedure codes are based on the official version of the World Health Organization s Ninth Revision, International Classification of Diseases (ICD-9). Volume 3 contains codes for operations and procedures performed on an inpatient basis Spinal fusion, not otherwise specified Atlas-axis spinal fusion Other cervical fusion, anterior technique Other cervical fusion, posterior technique Dorsal and dorsolumbar fusion, anterior technique Dorsal and dorsolumbar fusion, posterior technique Lumbar and lumbosacral fusion, anterior technique Lumbar and lumbosacral fusion, lateral transverse process technique Lumbar and lumbosacral fusion, posterior technique Refusion of spine, not otherwise specified Refusion of Atlas-axis spine Refusion of other cervical spine, anterior technique Refusion of other cervical spine, posterior technique Refusion of dorsal and dorsolumbar spine, anterior technique Refusion of dorsal and dorsolumbar spine, posterior technique Refusion of lumbar and lumbosacral spine, anterior technique Refusion of lumbar and lumbosacral spine, lateral transverse process technique Refusion of lumbar and lumbosacral spine, posterior technique Refusion of spine, not elsewhere classified degree spinal fusion, single incision approach Fusion or refusion of 2-3 vertebrae Fusion or refusion of 4-8 vertebrae Fusion or refusion of 9 or more vertebrae Insertion of interbody spinal fusion device

2 Report 2 CPT CODES The American Medical Association established Current Procedural Terminology (CPT) in 1966 to serve as a uniform language describing services and procedures performed by physicians and other health care professionals. These codes are used to accurately report medical, surgical, or diagnostic services rendered to a patient Arthrodesis, lateral extracavitary technique, including minimal diskectomy to prepare interspace (other than for decompression); thoracic Arthrodesis, lateral extracavitary technique, including minimal diskectomy to prepare interspace (other than for decompression); lumbar Arthrodesis, lateral extracavitary technique, including minimal diskectomy to prepare interspace (other than for decompression); thoracic or lumbar, each additional vertebral segment (List separately in addition to code for primary procedure) Arthrodesis, anterior transoral or extraoral technique, clivus-c1-c2 (atlas-axis), with or without excision of odontoid process Arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace (other than for decompression); cervical below C Arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace (other than for decompression); thoracic Arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace (other than for decompression); lumbar Arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace (other than for decompression); each additional interspace (List separately in addition to code for primary procedure) Arthrodesis, posterior technique, craniocervical (occiput-c2) Arthrodesis, posterior technique, atlas-axis (C1-C2) Arthrodesis, posterior or posterolateral technique, single level; cervical below C2 segment Arthrodesis, posterior or posterolateral technique, single level; thoracic (with or without lateral transverse technique) Arthrodesis, posterior or posterolateral technique, single level; lumbar (with or without lateral transverse technique) Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment (List separately in addition to code for primary procedure)

3 22630 Arthrodesis, posterior interbody technique, including laminectomy and/or diskectomy to prepare interspace (other than for decompression), single interspace; lumbar Arthrodesis, posterior interbody technique, including laminectomy and/or diskectomy to prepare interspace (other than for decompression), single interspace; each additional interspace (List separately in addition to code for primary procedure) Arthrodesis, posterior, for spinal deformity, with or without cast; up to 6 vertebral segments Arthrodesis, posterior, for spinal deformity, with or without cast; 7 to 12 vertebral segments Arthrodesis, posterior, for spinal deformity, with or without cast; 13 or more vertebral segments Arthrodesis, anterior, for spinal deformity, with or without cast; 2 to 3 vertebral segments Arthrodesis, anterior, for spinal deformity, with or without cast; 4 to 7 vertebral segments Arthrodesis, anterior, for spinal deformity, with or without cast; 8 or more vertebral segments Exploration of spinal fusion Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across one interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) Internal spinal fixation by wiring of spinous processes Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 7 to 12 vertebral segments Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 13 or more vertebral segments Anterior instrumentation; 2 to 3 vertebral segments Anterior instrumentation; 4 to 7 vertebral segments Anterior instrumentation; 8 or more vertebral segments Reinsertion of spinal fixation device Application of intervertebral biomechanical device(s) (eg, synthetic cage(s), threaded bone dowel(s), methylmethacrylate) to vertebral defect or interspace

4 Report 3 DIAGNOSIS RELATED GROUPS (S) Hospital inpatient procedures are paid to the hospital using the diagnosis related group () system. Each case is categorized into a, which has a payment weight assigned to it based on the average resources used to treat Medicare patients in that. Payment weights are adjusted based on geography, indigent patients, and hospital teaching status. Payment is also increased for particular cases that are unusually costly, known as outlier cases. 496 Combined anterior/posterior spinal fusion 497 Spinal fusion except cervical with CC 498 Spinal fusion except cervical without CC 519 Cervical spinal fusion with CC 520 Cervical spinal fusion without CC 531 Spinal procedures with CC 532 Spinal procedures without CC

5 Report 4 SPINAL FUSION TREND NUMBER OF DISCHARGES HCUP Spinal Fusion ICD-9-CM Px: , , , , , , , ,000 50, ICD-9-CM Procedures , , , ,846 49,827 62,705 91, , , , , , ,979 SOURCE: Healthcare Cost and Utilization Project (weighted national estimates).

6 Report 5 HCUP NUMBER OF SPINAL FUSION DISCHARGES BY TYPE OF INSURER, AGE, AND REGION Spinal Fusion HCUP ICD-9-CM Procedures: , , , Payer Growth Rate Commercial 112, % 133, % 151, % 17.3% Medicare 40, % 50, % 60, % 24.6% Other 30, % 37, % 42, % 19.1% Medicaid 12, % 17, % 19, % 26.1% Uninsured 3, % 3, % 3, % 7.8% Missing % % % -26.5% 199, % 243, % 276, % 19.4% SOURCE: Healthcare Cost and Utilization Project (weighted national estimates). Spinal Fusion - HCUP ICD-9-CM Procedures: , , , Category Growth Rate <1 * - * - * , % 9, % 9, % 11.7% , % 82, % 91, % 14.5% , % 106, % 124, % 23.0% , % 43, % 50, % 22.1% 85+ 1, % 1, % 1, % 20.5% Missing * - * - * - - Northeast 27, % 39, % 41, % 24.6% Midwest 46, % 52, % 65, % 20.4% South 86, % 101, % 113, % 15.7% West 39, % 49, % 56, % 22.4% SOURCE: Healthcare Cost and Utilization Project (weighted national estimates). Statistics based on 70 or fewer unweighted cases are not reliable. These statistics are suppressed and are designated with an asterisk (*).

7 Report 6 NHDS NUMBER OF SPINAL FUSION DISCHARGES BY TYPE OF INSURER, AGE, AND REGION Payer Spinal Fusion - NHDS ICD-9-CM Procedures: , , , Growth Rate Other Priv Ins 54, % 44, % 48, % -6.0% HMO/PPO 45, % 55, % 69, % 25.7% Medicare 35, % 46, % 58, % 32.5% BCBS 25, % 33, % 40, % 30.4% Worker's Comp 19, % 29, % 27, % 20.7% Medicaid 16, % 19, % 19, % 10.0% Other 8, % 7, % 9, % 10.4% Self Pay 6, % 2, % 2, % -33.2% Non Stated 4, % 7, % 6, % 24.2% Other Gov't 2, % 3, % 3, % 21.8% No Charge % % 1, % 137.6% 218, % 249, % 287, % 15.6% SOURCE: National Hospital Discharge Survey (weighted national estimates). Category Spinal Fusion - NHDS ICD-9-CM Procedures: , , , Growth Rate < % % % 121.3% , % 12, % 11, % 2.7% , % 85, % 88, % 7.4% , % 103, % 128, % 16.6% , % 44, % 56, % 33.3% % 2, % 1, % 246.6% Northeast 36, % 44, % 47, % 15.7% Midwest 50, % 56, % 59, % 9.3% South 82, % 96, % 114, % 19.6% West 50, % 52, % 65, % 15.6% SOURCE: National Hospital Discharge Survey (weighted national estimates).

8 Report 7 MEDICARE SPINAL FUSION DISCHARGES Medicare Spinal Fusion FY 2001 FY 2002 FY ,866 2,506 4, ,076 22,093 25, ,808 15,887 17, ,288 9,057 10, ,196 13,115 14, ,859 4, ,973 3,121 77,956 93, ,799 SOURCE: Medicare.

9 Report 8 PROJECTED NUMBER OF SPINAL FUSION DISCHARGES Projected Number of Spinal Fusion Category FY 2003 FY 2004 FY 2005 FY 2006 FY 2007 FY 2008 Medicare 78, , , , , , , , , , , ,972 SOURCE: FY 2003 from Medicare. Medicare projections based on estimates from 2002 payer mix (average Medicare growth rate of 28.5%). discharges extrapolated from Medicare and based on estimates from 2002 payer mix (average total growth rate of 17.5%).

10 Report 9 MEDICARE PHYSICIAN PAYMENT FOR SPINAL FUSION Estimated Medicare Physician Payment for Spinal Fusion CPT $1, $1, $ $1,778 $1,730 $1, $1,312 $1,279 $1, $1,593 $1,550 $1, $1,468 $1,429 $1, $355 $345 $ $1,433 $1,396 $1, $1,364 $1,329 $1, $1,148 $1,119 $1, $1,140 $1,112 $1, $1,457 $1,421 $1, $412 $402 $ $1,454 $1,421 $1, $335 $326 $ $1,274 $1,250 $1, $2,077 $2,034 $2, $2,431 $2,378 $2, $1,782 $1,742 $1, $2,014 $1,968 $1, $2,174 $2,120 $2, $777 $769 $ $802 $781 $ $0 $0 $ $805 $784 $ $844 $822 $ $1,050 $1,024 $1, $774 $751 $ $802 $779 $ $885 $860 $ $1,258 $1,292 $1, $426 $415 $411 SOURCE: Medicare. Estimated Medicare Payment based on national average conversion factors.

11 Report 10 MEDICARE HOSPITAL INPATIENT PAYMENT FOR SPINAL FUSION Medicare Inpatient Payment for Spinal Fusion Minimum $22,224 $13,316 $9,900 $9,488 $6,170 $11,946 $5,662 Maximum $72,612 $43,507 $32,345 $31,000 $20,159 $39,030 $18,501 Average $29,666 $17,775 $13,215 $12,665 $8,236 $15,946 $7,559 Median $27,623 $16,551 $12,305 $11,793 $7,669 $14,848 $7, Minimum $15,947 $9,333 $6,803 $6,477 $4, Maximum $68,338 $39,996 $29,153 $27,755 $18, Average $28,779 $16,843 $12,277 $11,688 $7, Median $26,806 $15,688 $11,436 $10,887 $7, SOURCE: Medicare.

12 Report 11 MEDICARE HOSPITALS PERFORMING THE MOST SPINAL FUSION PROCEDURES Hospitals Performing Most Spinal Fusion Procedures 2002 Hospital Medicare Estimated Procedures SWT Meth Hosp Meth Children s Hosp (Tx) 420 2,087 Abbott - Northwestern Hospital (MN) 379 1,883 Centennial Medical Center (TN) 372 1,848 Memorial Mission Hospital (NC) 330 1,639 Florida Hospital (FL) 314 1,560 UPMC, Presbyterian (PA) 299 1,485 Norton Hosp/Kosair Children's Hosp (KY) 283 1,406 Riverside Methodist Hospital (OH) 276 1,371 Baylor University Medical Center (TX) 252 1,252 Orlando Regional Medical Center (FL) 248 1,232 SOURCE: 2002 Medicare data. include s 496, 497, 498, 519, 520, 531, and 532. Estimated Procedures based on 2002 Medicare payer mix average. Hospitals Performing Most Spinal Fusion Procedures 2001 Hospital Medicare Estimated Procedures Centennial Medical Center (TN) 357 1,810 Abbott - Northwestern Hospital (MN) 330 1,673 SWT Meth Hosp Meth Children s Hosp (TX) 321 1,627 St Alphonsus Regional Medical Center (ID) 301 1,526 UPMC, Presbyterian (PA) 278 1,409 Florida Hospital (FL) 275 1,394 St Mary's Medical Center (MI) 269 1,364 Baylor University Medical Center (TX) 262 1,328 Holmes Regional Medical Center (FL) 250 1,268 Memorial Mission Hospital (Nc) 241 1,222 SOURCE: 2001 Medicare data. include s 496, 497, 498, 519, 520, 531, and 532. Estimated Procedures based on 2001 Medicare payer mix average.