Exclude all patients <20.0 years of age as of the listed discharge date. Then:
Exclude if listed in any diagnosis field:
ICD-9-CM Diagnosis
Code
140-239.9
324.1
630-676
720.0-720.9
Description
All neoplasms
Intraspinal abscess
Pregnancy-related diagnoses
Inflammatory spondyloarthropathies
730-730.99
733.1, 733.10, 733.13
733.8, 733.81-733.82
805-806.9
Osteomyelitis
Pathologic fracture, incl unspecified site (733.10) or vertebrae (733.13)
Non-union/mal-union of fracture
Fractures of spinal column
839-839.59
E800-E849.9
All vertebral dislocations
Vehicular accidents
Exclude if listed as first diagnosis; do not exclude if it is a secondary diagnosis
ICD-9-CM Diagnosis
Code
353.2, 353.3
721.0, 721.2
721.1, 721.41
Description
Cervical/thoracic root lesion
Cervical/thoracic spondylosis without myelopathy
Cervical/thoracic spondylosis with myelopathy
722.0, 722.11
722.4
722.71, 722.72
722.81, 722.82
722.91, 722.92
723.0
723.4
724.01
Displacement cervical/thoracic disc
Degeneration of cervical disc
Cervical/thoracic disc disease with myelopathy
Cervical/thoracic disc post laminectomy syndrome
Unspecified disc disorder, cervical/thoracic
Cervical spinal stenosis
Brachial neuritis
Thoracic spinal stenosis
Exclude if listed in any procedure field
CPT-4 Procedure
Code
22554
22556
Description
Neck spine fusion
Thoracic spine fusion
22600
63020
63075
63076
ICD-9-CM Procedure
Code
03.2-03.29
81.01
81.02
81.03
Cervical arthrodesis, posterior approach
Cervical laminotomy
Diskectomy, cervical, anterior (R84)
Neck spine surgery
Description
Chordotomy
Atlas-axis fusion
Other cervical fusion
Dorsal fusion

Appendix Table 2 : Lumbar-specific ICD-9-CM procedure codes , requiring no specific diagnosis code. A case with a code from Table 2 is always “definite” (unless excluded by Table 1).
ICD-9-CM Procedure
Code
Fusion
Description
81.06
81.07
81.08
Lumbar spinal fusion
Lumbosacral spinal fusion
Refusion of spine (coding specified lumbar spine as of mid-late 1990s)

Appendix Table 3.
: Lumbar-specific CPT-4 procedure codes , requiring no specific diagnosis code. A case with a cod e from Table 3 is always “definite” (unless excluded by Table 1).
CPT-4 Procedure Code Description
Lumbar Diskectomy
63030
Laminotomy w/Partial Facetectomy/Foraminotomy/Herniated Diskectomy; 1 Interspace,
Lumbar
63042
63056
Lumbar Laminectomy
22102
Laminotomy w/Partial Facetectomy/Foraminotomy/Herniated Diskectomy; Re-Exploration,
Lumbar
Transpedicular Approach, 1 Segment; Lumbar (Transfacet/Lateral Extraforaminal)
Partial Excision, Posterior Vertebral Component, Single; Lumbar
63005
63012
63017
63047
63200
63267
Laminectomy w/o Facetectomy/Foraminotomy/Diskectomy, 1 to 2 Segments; Lumbar
Laminectomy w/Removal of Abnormal Facets, etc for spondylolisthesis; Lumbar
Laminectomy w/o Facetectomy/Foraminotomy/Diskectomy, 2 Segments; Lumbar
Laminectomy, Facetectomy & Foraminotomy, 1 Segment; Lumbar
Laminectomy, w/Release, Tethered Spinal Cord, Lumbar
Laminectomy, Excision, Non-neoplastic Lesion, Extradural; Lumbar
63272 Laminectomy, Excision, Intraspinal Lesion Other than Neoplasm, Intradural; Lumbar
Lumbar Spinal Fusion Without Mention of Hardware
22558
22612
22625
22630
22650
Arthrodesis, Anterior Interbody,; Lumbar
Arthrodesis, Posterior/Posterolateral, Single Level; Lumbar
Lumbar Spine Fusion
Arthrodesis, Posterior Interbody, w/Laminectomy/Diskectomy, Single Interspace; Lumbar
Lumbar Spine Fusion, Extra (addtl) Segment (was replaced by 22614)

Appendix Table 4 : Back-specific ICD-9-CM procedure codes (which do not specify lumbar spine).
A case with a procedure code from this Table is selecte d as “definite” if there is also a diagnosis from Table 6. A case with a procedure code from this Table is selected as “possible” if there is also a diagnosis from Table 7 or from Table 8. However, as code 78.69 is not specific to the spine, a definite or possible case must also have a procedure code other than 78.69 in order to be included. If a case with a procedure code from Table 4 has no diagnosis from Table 6, 7, or 8, the case is not selected. If there is no procedure code from Table 4 (other than 78.69) and no procedure code from
Table 5 AND a diagnosis code from Table 8 (but none from Table 6 or 7), the case is not selected.
ICD-9-CM
Procedure Code Description
Laminectomy
03.0
03.09
Diskectomy
80.5
80.50
80.51
80.52
Exploration and decompression of spinal canal structures
Other exploration and decompression of spinal canal
Excision or destruction of intervertebral disc
Other destruction of intervertebral disc
Excision or destruction of intervertebral disc unspecified
Excision of intervertebral disc
Intervertebral chemonucleolysis
80.59
Fusion
81.00
81.05
81.09
Removal of hardware
78.69
Other
03.02
03.6
Spinal fusion, not otherwise specified
Dorsal/dorsolumbar fusion, posterior technique
Other spinal fusion (Not Elsewhere Classified)
Removal of internal fixation device (vertebral, pelvic, or phalangeal)
Reopening of laminectomy site
Lysis of adhesions of cord or nerve root

Appendix Table 5: Back-specific CPT-4 codes . A case with a code from this Table is selected as
“definite” if there is also a diagnosis from Table 6. A case with a code from this Table is selected as
“possible” if there is also a diagnosis from Table 7 or 8. If there is no diagnosis code from Table 6, 7 or
8, the case is not selected.
CPT-4 code Description
Spinal Fusion Modifications
20930
20931
20937
20938
Allograft, Spine Surgery Only; Morselized (not specifically lumbar)
Allograft, Spine Surgery Only; Structural (not specifically lumbar)
Autograft, Spine Surgery; Morselized, Separate Incision (not specifically lumbar)
Autograft, Spine Surgery; Structural, Bicortical/Tricortical, Separate Incision (not specifically lumbar)
22585
22614
Arthrodesis, Each Additional Anterior Interspace (not specifically lumbar)
Arthrodesis, Posterior/Posterolateral, Single Level; Add'l Segment
22632 Arthrodesis, Posterior Interbody, Single Interspace; Add'l Interspace
Fusion Plus Hardware (not specifically lumbar)
22841
22842
Int Spinal Fixation, Wiring, Spinous Processes
Posterior Segmental Instrumentation: 3-6 Vertebral Segments
22843
22844
22845
22846
Posterior Segmental Instrumentation: 7-12 Vertebral Segments
Posterior Segmental Instrumentation: 13+ Vertebral Segments
Anterior Instrumentation: 2 to 3 Vertebral Segments
Anterior Instrumentation: 4 to 7 Vertebral Segments
22847
22849
Anterior Instrumentation: 8+ Vertebral Segments
Reinsertion, Spinal Fixation Device
22851 Application of Intervertebral Biomechanical Device
Diskectomy (not specifically lumbar)
63035
63057
Laminotomy w/Partial Facetectomy/Foraminotomy/Herniated Diskectomy, Add'l Interspace,
Cervical/Lumbar
Transpedicular Approach, Add'l Segment, Thoracic/Lumbar (Transfacet/Lateral
Extraforaminal)
Laminectomy (not specifically lumbar)
63048 Laminectomy, Facetectomy & Foraminotomy; Add'l Segment, Cervical/Thoracic/Lumbar
Removal of Hardware (not specifically lumbar)
22850 Removal, Posterior Nonsegmental Instrumentation (not specifically lumbar)
22852
22855
Removal, Posterior Segmental Instrumentation (not specifically lumbar)
Removal, Anterior Instrumentation (not specifically lumbar)
Other (not specifically lumbar)
22830 Exploration of spinal fusion (not specifically lumbar)
28999
63707
63709
63710
Spine Surgery procedure (not specifically lumbar)
Repair spinal fluid leakage
Repair spinal fluid leakage
Graft repair of spine defect

Appendix Table 6
: Diagnosis codes for “definite” low back surgery
A case with any diagnoses in
Table 2 and any procedure code in Table 4 or 5 is selected as “definite”.
ICD-9-CM
Description Diagnosis Code
Herniated Disc
722.10
722.73
Disc Degeneration
Displacement of lumbar disc
Herniated lumbar disc with myelopathy
721.3
722.52
722.93
Spinal Stenosis
721.42
724.02
Possible Instability
Lumbrosacral spondylosis, no myelopathy
Degeneration of lumbar disc
Lumbar disc displacement NOS
Spondylogenic compression of lumbar spinal cord
Lumbar stenosis
724.6
738.4
756.11
756.12
Disorders of sacrum: includes instability of lumbrosacral joint
Acquired spondylolisthesis (included because these are overwhelmingly lumbar)
Spondylolysis, lumbar
Spondylolisthesis (included because these are overwhelmingly lumbar)
Miscellaneous low back problems
353.4 Lumbrosacral root lesions
355.0
722.83
724.2
724.3
739.3
739.4
846.0-846.9
847.2
847.3
Sciatic nerve lesion
Postlaminectomy syndrome, lumbar
Lumbago
Sciatica
Non-allopathic lesions, lumbar spine
Non-allopathic lesions, sacral region
Sprains and strains, lumbosacral and other sacral ligaments
Sprains and strains, lumbar
Sprains and strains, sacral

Appendix Table 7:
Diagnosis codes for “possible” low back surgery
A case with any diagnosis code in Table 7 and any procedure code (including 78.69) in Table 4 or 5 (but no procedure code in
Table 2) is selected as “possible”
ICD-9-CM
Diagnosis Code Description
353.8
721.5
721.0-721.91
722.10-722.19
722.2
722.6
722.70
Nerve root/plexus disease NEC
Kissing spine
Spondylosis, unspecified site
Displacement of thoracic or lumbar intervertebral disc without myelopathy
Herniated disc, unspecified site
Degeneration intervertebral disc, unspecified site
Intervertebral disc disorder with myelopathy, site unspecified
722.80
722.90
724.00
724.09
724.4
724.5
724.8
724.9
Post-laminectomy syndrome, unspecified region
Other and unspecified disc disorder, unspecified region
Stenosis, unspecified site, not cervical
Stenosis, other, not cervical
Thoracic or lumbrosacral neuritis or radiculitis
Backache, unspecified
Other symptoms referable to back
Other unspecified back disorders
Sprain and strain, unspecified part of back 847.9

Appendix Table 8.
Diagnosis codes for “possible” low back surgery when there is a procedure code from Table 4 (other than 78.69) or from Table 5 A case with any procedure code other than
78.69
in Table 4 or any procedure code in Table 5, and any diagnosis code in Table 8 (but no diagnosis code in Table 6 or Table 7), is selected as “possible”. If there is no procedure code in Table
4 other than 78.69, and no procedure code in Table 5, and a diagnosis code in Table 8 but not in Table
6 or 7, the case is not selected.
ICD-9-CM
Diagnosis Code Description
729.2
996.4
996.70
996.75
996.78
996.79
E878.1
E878.8
V45.4
V53.09
V54.0
V54.8
Neuralgia/neuritis NOS
Mechanical complication of orthopædic device
Complications of internal prosthetic device
Complications of nervous system device/graft
Complications of other internal orthopædic device
Complications of internal prosthetic device NEC
Abnormal reaction to implant
Abnormal reaction to surgical procedure
Arthrodesis status
Adjust nervous system device
Removal of internal fixation device
Orthopædic aftercare NEC

Any exclusions per instructions in Table 1?
Yes
Exclude
No
Definite lumbar surgery procedure code from
Table 2 (ICD-9-CM procedures) or from Table
3 (CPT-4 procedures)?
No Yes
Possible lumbar surgery procedure code from Table 4 (ICD-9-CM procedures) or from Table 5 (CPT-4 procedures)?*
No Yes
Don’t include Definite
Include as definite lumbar surgery procedure
lumbar diagnosis code from Table 6?*
Possible lumbar diagnosis code from Table 7 or
Table 8?*
Yes
Include as definite lumbar surgery procedure*
No
Don’t include
Yes
Include only as possible lumbar surgery procedure*
* Cases with ICD-9-CM procedure code 78.69 (removal of internal fixation device from vertebrae , pelvis or phalanges) as the only “possible” lumbar surgery code are included as “definite” cases only if accompanied by definite diagnosis codes (Table 6). Such cases are included as “possible” cases only if accompanied by selected possible diagnosis codes (Table 7).