Department of Neurosurgery, Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Spine (Phila Pa 1976). 2011 Oct 15;36(22):1843-8. doi: 10.1097/BRS.0b013e3181f7a943.
Retrospective study.
To evaluate the sensitivity and specificity of a combined Current Procedural Terminology (CPT) and International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) algorithm in defining cervical spine surgery in comparison to patient operative reports in the medical record.
Epidemiological studies of spine surgery often use ICD-9-CM billing codes in administrative databases to study trends and outcome of surgery. However, ICD-9-CM codes do not clearly identify specific surgical factors that may be related to outcome, such as instrumentation or number of levels treated. Previous studies have not investigated the sensitivity and specificity of a combined CPT and ICD-9-CM code algorithm for defining cervical spine surgical procedures.
We performed a retrospective study comparing the sensitivity and specificity of a combined CPT and ICD-9-CM code algorithm to the operative note, the gold standard, in a single academic center. We also compared the accuracy of our combined algorithm with our published ICD-9-CM-only algorithm.
The combined algorithm has high sensitivity and specificity for defining cervical spine surgery, specific surgical procedures such as discectomy and fusion, and surgical approach. Compared to the ICD-9-CM-only algorithm, the combined algorithm significantly improves identification of discectomy, laminectomy, and fusion procedures and allows identification of specific procedures such as laminaplasty and instrumentation with high sensitivity and specificity. Identification of reoperations has low sensitivity and specificity, but identification of number of levels instrumented, fused, and decompressed has high specificity.
The use of our combined CPT and ICD-9-CM algorithm to identify cervical spine surgery was highly sensitive and specific. For categories such as surgical approach, accuracy of our combined algorithm was similar to that of our ICD-9-CM-only algorithm. However, the combined algorithm improves sensitivity, and allows identification of procedures not defined by ICD-9-CM procedure codes, and number of levels instrumented and decompressed. The combined algorithm better defines cervical spine surgery and specific factors that may impact outcome and cost.
回顾性研究。
评估当前程序术语（CPT）和国际疾病分类，第九修订版，临床修正（ICD-9-CM）算法组合在定义颈椎手术方面的敏感性和特异性，与病历中的患者手术报告进行比较。
脊柱手术的流行病学研究通常在行政数据库中使用 ICD-9-CM 计费代码来研究手术趋势和结果。然而，ICD-9-CM 代码并不能清楚地确定可能与结果相关的特定手术因素，例如器械或治疗的水平数量。以前的研究尚未调查 CPT 和 ICD-9-CM 代码算法组合用于定义颈椎手术程序的敏感性和特异性。
我们在单一学术中心进行了一项回顾性研究，比较了 CPT 和 ICD-9-CM 代码算法组合与手术记录（金标准）的敏感性和特异性。我们还比较了我们的组合算法与我们已发表的 ICD-9-CM 算法的准确性。
该组合算法在定义颈椎手术、特定手术程序（如椎间盘切除术和融合术）和手术入路方面具有很高的敏感性和特异性。与 ICD-9-CM 算法相比，组合算法显著提高了椎间盘切除术、椎板切除术和融合术的识别能力，并允许以高敏感性和特异性识别特定手术程序，如椎板成形术和器械。再次手术的识别具有较低的敏感性和特异性，但识别器械化、融合和减压的水平具有较高的特异性。
使用我们的 CPT 和 ICD-9-CM 算法组合来识别颈椎手术具有很高的敏感性和特异性。对于手术入路等类别，我们的组合算法的准确性与我们的 ICD-9-CM 算法相似。然而，组合算法提高了敏感性，并允许识别 ICD-9-CM 程序代码未定义的程序以及器械化和减压的水平。组合算法更好地定义了颈椎手术和可能影响结果和成本的特定因素。
