Appendix D. Methodology Enhancements for 2007 Ratings Models
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Orthopedics (continued)
Cohorts Affected
2007 Ratings' Model Change
Rationale for Changes
Back and Neck
Surgery (excluding
fusion)
Spinal Fusion
Exclude vertebroplasty (81.65)
and kyphoplasty (81.66)
Vertebroplasty and kyphoplasty are minimally
invasive, non-surgical procedures and therefore are
not appropriate for inclusion in the back and neck
surgery analysis.
Back and Neck
Surgery (excluding
fusion)
Spinal Fusion
Exclude removal of disc
prosthesis (84.60-84.65) and
revisions of artificial spinal disc
prostheses (84.66-84.69)
Exclude patients with V-codes for
encounter for removal of internal
fixation device and aftercare
involving internal fixation device
(v5401, v5409)
Patients with a history of previous spinal surgery may
have "failed hardware" which is frequently coded with
a primary diagnosis of complication of the joint
prosthesis or mechanical failure of the device. In
these instances, the mechanical complication would
appear to be a postoperative complication. Therefore,
these patients are excluded from the analysis.
Back and Neck
Surgery (excluding
fusion)
Spinal Fusion
Exclude patients with history of
bone transplants (v42.4)
This situation is infrequent and when it does occur,
these patients may not be adequately risk adjusted
due to the low volume and not reaching the statistical
significance required to remain in the final prediction
model thus necessitating exclusion from the patient
population evaluated.
Spinal Fusion
Exclude patients with implantation
of interspinous process
decompression device (84.58)
This procedure is minimally invasive alternative to
traditional spinal fusion surgery and therefore not
appropriate for inclusion in the spinal fusion cohort.
