Icd-9 Code Description



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Supplemental Digital Content 1: Low Back Injury Severity Code Groups Based on ICD-9 Codes (1)


ICD-9 Code

Description

More Severe

344.60

Syndrome, cauda equina NOS

344.61

Synd, cauda equina w/neuro bladder

353.1

Lesions, lumbosacral plexus

353.4

Lesions, lumbosacral root NEC

353.8

Disorder, nerve root/plexus NEC

353.9

Disorder, nerve root/plexus NOS

355.0

Lesion, sciatic nerve

721.42

Spondylosis, lumbar w/myelopathy

722

Disorders, intervertebral disc

722.1

Dsplcmnt thorc/lmbr disc w/o myelpy

722.10

Dsplcmnt, lumbar disc w/o myelpy

722.2

Displacement, disc NOS w/o myelpy

722.7

Dsord, intervertebral disc w/myelpy

722.70

Disorder, disc NOS w/myelopathy

722.73

Disorder, lumbar disc w/myelopathy

722.83

Syndrome, postlaminectomy, lumbar

724.0

Stenosis, spinal, oth than cervical

724.00

Stenosis, spinal, unspec region

724.02

Stenosis, spinal, lumbar

724.09

Stenosis, spinal, other spec site

724.3

Sciatica

724.4

Neuritis, lumbosacral NOS

724.6

Disorders, sacrum (incl. LS jt. instability)

729.2

Neuralgia/neuritis NOS

738.4

Spondylolisthesis, acquired

756.1

Anomaly, congenital, spine

756.10

Anomaly, congenital, spine NOS

756.11

Spondylolysis, cngn, lumbosacral

756.12

Spondylolisthesis, congenital

953.2

Injury, lumbar root

953.5

Injury lumbosacral plexus

956.0

Injury sciatic nerve




Less Severe

349.9

Disorder, nervous system NOS

720.0

Spondylitis, ankylosing

720.1

Enthesopathy, spinal

720.2

Sacroiliitis NEC

720.9

Spondylopathy, inflammatory NOS

721.3

Spondylosis, lumbosacral

721.7

Spondylopathy, traumatic

721.8

Disorder, spinal NEC

721.9

Spondylosis NOS

721.90

Spondylosis NOS w/o myelopathy

722.32

Schmorl's nodes, lumbar region

722.5

Dgnratn, thorc/lumbar disc

722.52

Degeneration, lumbar/lmbsac disc

722.6

Degeneration, disc NOS

722.9

Dsord, intrvrtbrl disc, oth & unspc

722.90

Disorder NEC/NOS, unspecified disc

722.93

Disorder NEC/NOS, lumbar disc

724

Disorders, back, other & unspc

724.2

Lumbago

724.5

Backache NOS

724.7

Disorders, coccyx

724.71

Hypermobility, coccyx

724.79

Disorder, coccyx NEC

724.8

Symptom, back NEC

724.9

Disorder, back NOS

728.2

Atrophy, muscular disuse NEC

728.8

Disorders, muscle/ligament/fascia

728.85

Spasm, muscle

728.9

Disorder, muscle/ligament NOS

729.1

Myalgia/myositis NOS

729.9

Disorder, soft tissue NEC/NOS

737.3

Kyphoscoliosis and scoliosis

737.30

Scoliosis, idiopathic

737.39

Scoliosis NEC

738.5

Deformity, acquired, back/spine NEC

739.3

Lesion, nonallopathic, lumbar rgn

739.4

Lesion, nonallopathic, sacral rgn

756.15

Fusion, spine, congenital

793.7

Nonspecif abnl radiolog fnd, musculoskl systm

799.8

Condition, ill-defined NEC

839.2

Dsloc, thoracic/lumbar vrt, clsd

839.20

Dsloc lumbar vertebra, closed

839.42

Dislocation sacrum, closed

839.69

Dislocation site NEC, closed

839.8

Dislocation, mlt/ill-defined, clsd

846

Sprain/strain, sacroiliac region

846.0

Sprain/strain, lumbosacral

846.1

Sprain/strain, sacroiliac ligament

846.2

Sprain/strain, sacrospinatus

846.3

Sprain/strain, sacrotuberous

846.8

Sprain/strain, sacroiliac site NEC

846.9

Sprain/strain, sacroiliac site NOS

847

Sprains/strain oth/unspc parts back

847.2

Sprain/strain, lumbar region

847.3

Sprain/strain, sacrum

847.4

Sprain/strain, coccyx

847.9

Sprain/strain, back NOS

848.8

Sprain/strain NEC

848.9

Sprain/strain NOS

905.7

Late effect, sprain/strain

922.3

Contusion, back

922.31

Contusion, back

922.32

Contusion, buttock

922.9

Contusion, trunk NOS

959.1

Injury NOS, trunk

959.19

Injury NOS, other sites trunk

Supplemental Digital Content 2: Current Procedural Terminology (CPT) Codes for Identifying Medical Services (2)




Category of Service

CPT Code

Description

Advanced Imaging

62284

Injection procedure for myelography and/or computed tomography, spinal (other than C1-C2 and posterior fossa)

62290

Injection procedure for discography, each level; lumbar

62292

Injection procedure for chemonucleolysis, including discography, intervertebral disc, single or multiple levels, lumbar

72131

Computed tomography, lumbar spine; without contrast material

72132

Computed tomography, lumbar spine; with contrast material

72133

Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections

72148

Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material

72149

Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; with contrast material(s)

72158

Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; lumbar

72265

Myelography, lumbosacral, radiological supervision and interpretation

72270

Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical), radiological supervision and interpretation

72295

Discography, lumbar, radiological supervision and interpretation

78315

Bone and/or joint imaging; 3 phase study

78320

Bone and/or joint imaging; tomographic (SPECT)

78399

Unlisted musculoskeletal procedure, diagnostic nuclear medicine

EMG / NCV

95860

Needle electromyography; 1 extremity with or without related paraspinal areas

95861

Needle electromyography; 2 extremities with or without related paraspinal areas

95900

Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study

95903

Nerve conduction, amplitude and latency/velocity study, each nerve; motor, with F-wave study

95904

Nerve conduction, amplitude and latency/velocity study, each nerve; sensory

95905

Motor and/or sensory nerve conduction, using preconfigured electrode array(s), amplitude and latency/velocity study, each limb, includes F-wave study when performed, with interpretation and report

95907

Nerve conduction studies; 1-2 studies

95926

Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in lower limbs

95934

H-reflex, amplitude and latency study; record gastrocnemius/soleus muscle

Injections (Epidural Steroid Injections)

62311

Injection(s), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid; lumbar or sacral (caudal)

62319

Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, includes contrast for localization when performed, epidural or subarachnoid; lumbar or sacral (caudal)

64483

Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level

64484

Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional level (List separately in addition to code for primary procedure)

Injections

20552

Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)

20553

Injection(s); single or multiple trigger point(s), 3 or more muscle(s)

27096

Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performed

62264

Percutaneous lysis of epidural adhesions using solution injection (eg, hypertonic saline, enzyme) or mechanical means (eg, catheter) including radiologic localization (includes contrast when administered), multiple adhesiolysis sessions; 1 day

62282

Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline solutions), with or without other therapeutic substance; epidural, lumbar, sacral (caudal)

64475

Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; lumbar or sacral, single level (changed to 64493)

64476

Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; lumbar or sacral, each additional level (List separately in addition to code for primary procedure) (changed to 64494 and 64495)

64493

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level

64494

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; second level (List separately in addition to code for primary procedure)

64495

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; third and any additional level(s) (List separately in addition to code for primary procedure)

64520

Injection, anesthetic agent; lumbar or thoracic (paravertebral sympathetic)

64622

Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level (changed to 644635)

64623

Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, each additional level (List separately in addition to code for primary procedure) (changed to 644636)

64635

Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint

64636

Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional facet joint (List separately in addition to code for primary procedure)

Surgery

22224

Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; lumbar

22226

Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; each additional vertebral segment (List separately in addition to code for primary procedure)

22840

Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure)

22841

Internal spinal fixation by wiring of spinous processes

22842

Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure)

22899

Spine Surgery Procedure (unlisted)

62287

Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method, single or multiple levels, lumbar (eg, manual or automated percutaneous discectomy, percutaneous laser discectomy)

63005

Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), 1 or 2 vertebral segments; lumbar, except for spondylolisthesis

63011

Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), 1 or 2 vertebral segments; sacral

63012

Laminectomy with removal of abnormal facets and/or pars inter-articularis with decompression of cauda equina and nerve roots for spondylolisthesis, lumbar (Gill type procedure)

63017

Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), more than 2 vertebral segments; lumbar

63030

Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, including open and endoscopically-assisted approaches; 1 interspace, lumbar

63035

Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, including open and endoscopically-assisted approaches; each additional interspace, cervical or lumbar (List separately in addition to code for primary procedure)

63042

Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; lumbar

63044

Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; each additional lumbar interspace (List separately in addition to code for primary procedure)

63047

Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar

63048

Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; each additional segment, cervical, thoracic, or lumbar (List separately in addition to code for primary procedure)

63056

Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated intervertebral disc), single segment; lumbar (including transfacet, or lateral extraforaminal approach) (eg, far lateral herniated intervertebral disc)

63057

Transpedicular approach with decompression, each additional segment, lumbar

63170

Laminectomy with myelotomy (eg, Bischof or DREZ type), cervical, thoracic, or thoracolumbar

63185

Laminectomy with rhizotomy, 1-2 segments

63190

Laminectomy with rhizotomy, more than 2 segments

63200

Laminectomy, with release of tethered spinal cord, lumbar

63267

Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; lumbar

63268

Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; sacral

63272

Laminectomy for excision of intraspinal lesion other than neoplasm, intradural; lumbar

63273

Laminectomy for excision of intraspinal lesion other than neoplasm, intradural; sacral

69990

Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure)

72291

Radiological supervision and interpretation, percutaneous vertebroplasty, vertebral augmentation, or sacral augmentation (sacroplasty), including cavity creation, per vertebral body or sacrum; under fluoroscopic guidance

Surgery (Fusions)

22632

Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; each additional interspace (List separately in addition to code for primary procedure)

22650

deleted code, replaced by 22614

22820

Deleted, replaced with 20930-20938

22830

Exploration of spinal fusion

22840

Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure)

22841

Internal spinal fixation by wiring of spinous processes

22842

Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure)

22849

Reinsertion of spinal fixation device

22850

Removal of posterior nonsegmental instrumentation (eg, Harrington rod)

22851

Application of intervertebral biomechanical device(s) (eg, synthetic cage(s), threaded bone dowel(s), methylmethacrylate) to vertebral defect or interspace (List separately in addition to code for primary procedure)

22852

Removal of posterior segmental instrumentation

22855

Removal of anterior instrumentation


References

  1. Commission on Professional and Hospital Activities. International Classification of Diseases, 9th Revision, Clinical Modification, ICD-9-CM. Ann Arbor, MI: Edwards Brothers, Inc., 1980.

  2. American Medical Association. Current Procedural Terminology (CPT). Chicago: American Medical Association, 2002.

Supplemental Digital Content 3. Severity Comparisons Within MRI Groups at 6 Months Post-MRI




More Severe vs. Less Severe (ref.)

Injections

EMG/NCV

Advanced Imaging

Surgery

RR

95% CI

Sig.

RR

95% CI

Sig.

RR

95% CI

Sig.

RR

95% CI

Sig.

No MRI

2.70

(1.29, 5.67)

p = 0.009

4.59

(1.24, 16.98)

p = 0.02

0.48

(0.06, 3.66)

p = 0.48

1.64

(0.34, 7.83)

p = 0.54

Early MRI

1.19

(1.02, 1.40)

p = 0.03

1.44

(1.03, 2.03)

p = 0.04

1.15

(0.83, 1.60)

p = 0.40

1.19

(0.85, 1.67)

p = 0.31

Timely MRI

1.04

(0.81, 1.34)

p = 0.75

1.22

(0.73, 2.03)

p = 0.45

0.79

(0.46, 1.34)

p = 0.37

3.10

(1.26, 7.65)

p = 0.01

Abbreviations: MRI, magnetic resonance imaging; EMG/NCV, electromyography/nerve conduction velocity; ref., reference group; RR, relative risk; Sig., significance of the estimate. Multivariate log binomial model results comparing those with higher severity against those with low severity (as the reference group) within each MRI group. Estimates of risk ratios (relative risk) are adjusted for age, gender, job tenure, and use of early opioids. Wald 95% CI shown in parentheses.







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