Page 1 Appendix TABLE E-1 Codes (and Definitions) in Humana Database Used for Study Inclusion and Exclusion of Patients Who Underwent,, or 1 to 2-Level Inclusion ICD-9-P-8154 Total knee replacement ICD-9-D-71596 Osteoarthrosis, unspecified whether generalized or localized, lower leg ICD-9-D-71536 Osteoarthrosis, localized, not specified whether primary or secondary, lower leg ICD-9-D-71516 Osteoarthrosis, localized, primary, lower leg ICD-9-D-71590 CPT-27447 ICD-9-P-8151 ICD-9-D-71595 ICD-9-D-71535 ICD-9-D-71515 ICD-9-D-71590 CPT-27130 ICD-9-P-8107 ICD-9-P-8108 ICD-9-P-8162 ICD-9-D-72402 ICD-9-D-7384 ICD-9-D-72252 ICD-9-D-72210 ICD-9-D-7213 ICD-9-D-7244 ICD-9-D-75612 ICD-9-D-72403 Exclusion //: coexisting or prior diagnoses/procedures ICD-9-D-8208 ICD-9-D-71695 ICD-9-D-7140 ICD-9-D-82009 ICD-9-D-9596 ICD-9-D-E8859 ICD-9-D-75563 ICD-9-D-82021 ICD-9-D-82100 ICD-9-D-82000 ICD-9-D-82003 ICD-9-D-73314 ICD-9-D-9053 ICD-9-D-82020 ICD-9-D-8080 ICD-9-D-8209 ICD-9-D-8088 ICD-9-D-82101 Osteoarthrosis, unspecified whether generalized or localized, site unspecified Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty) Hip joint replacement Osteoarthrosis, unspecified whether generalized or localized, pelvic region and thigh Osteoarthrosis, localized, not specified whether primary or secondary, pelvic region and thigh Osteoarthrosis, localized, primary, pelvic region and thigh Osteoarthrosis, unspecified whether generalized or localized, site unspecified Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft Lumbar and lumbosacral fusion of the posterior column, posterior technique Lumbar and lumbosacral fusion of the anterior column, posterior technique Fusion or refusion of 2-3 vertebrae Spinal stenosis, lumbar region, without neurogenic claudication Acquired spondylolisthesis Degeneration of lumbar or lumbosacral intervertebral disc Displacement of lumbar intervertebral disc without myelopathy Lumbosacral spondylosis without myelopathy Thoracic or lumbosacral neuritis or radiculitis, unspecified Spondylolisthesis Spinal stenosis, lumbar region, with neurogenic claudication Closed fracture of unspecified part of neck of femur Arthropathy, unspecified, pelvic region and thigh Rheumatoid arthritis Other closed transcervical fracture of neck of femur Hip and thigh injury Fall from other slipping, tripping, or stumbling Other congenital deformity of hip (joint) Closed fracture of intertrochanteric section of neck of femur Closed fracture of unspecified part of femur Closed fracture of intracapsular section of neck of femur, unspecified Closed fracture of base of neck of femur Pathologic fracture of neck of femur Late effect of fracture of neck of femur Closed fracture of trochanteric section of neck of femur Closed fracture of acetabulum Open fracture of unspecified part of neck of femur Closed unspecified fracture of pelvis Closed fracture of shaft of femur Page 1 of 6
Page 2 ICD-9-D-99644 ICD-9-P-7935 ICD-9-P-7915 ICD-9-P-0080 ICD-9-P-0074 ICD-9-P-0077 ICD-9-P-0075 ICD-9-P-8152 ICD-9-P-8086 ICD-9-P-0070 ICD-9-P-7865 ICD-9-P-0081 ICD-9-P-8456 ICD-9-P-8006 ICD-9-P-7855 ICD-9-P-0082 ICD-9-P-0071 ICD-9-P-8005 ICD-9-P-0073 ICD-9-P-0083 ICD-9-P-0084 ICD-9-P-0076 ICD-9-P-0072 ICD-9-D-3241 ICD-9-D-34400 ICD-9-D-3441 ICD-9-D-34460 ICD-9-D-34461 ICD-9-D-7210 ICD-9-D-7211 ICD-9-D-72141 ICD-9-D-7220 ICD-9-D-72211 ICD-9-D-72271 ICD-9-D-72272 ICD-9-D-72283 ICD-9-D-7230 ICD-9-D-72401 ICD-9-D-73028 ICD-9-D-73730 ICD-9-D-73739 ICD-9-D-8052 ICD-9-D-8054 ICD-9-D-V454 ICD-9-P-8102 ICD-9-P-8103 ICD-9-P-8104 ICD-9-P-8105 ICD-9-P-8106 ICD-9-P-8163 ICD-9-P-8164 Peri-prosthetic fracture around prosthetic joint Open reduction of fracture with internal fixation, femur Closed reduction of fracture with internal fixation, femur Revision of knee replacement, total (all components) Hip bearing surface, metal-on-polyethylene Hip bearing surface, ceramic-on-polyethylene Hip bearing surface, metal-on-metal Partial hip replacement Other local excision or destruction of lesion of joint, knee Revision of hip replacement, both acetabular and femoral components Removal of implanted devices from bone, femur Revision of knee replacement, tibial component Insertion or replacement of (cement) spacer Arthrotomy for removal of prosthesis without replacement, knee Internal fixation of bone without fracture reduction, femur Revision of knee replacement, femoral component Revision of hip replacement, acetabular component Arthrotomy for removal of prosthesis without replacement, hip Revision of hip replacement, acetabular liner and/or femoral head only Revision of knee replacement, patellar component Revision of total knee replacement, tibial insert (liner) Hip bearing surface, ceramic-on-ceramic Revision of hip replacement, femoral component Intraspinal abscess Quadriplegia, unspecified Paraplegia Cauda equina syndrome without mention of neurogenic bladder Cauda equina syndrome with neurogenic bladder Cervical spondylosis without myelopathy Cervical spondylosis with myelopathy Spondylosis with myelopathy, thoracic region Displacement of cervical intervertebral disc without myelopathy Displacement of thoracic intervertebral disc without myelopathy Intervertebral disc disorder with myelopathy, cervical region Intervertebral disc disorder with myelopathy, thoracic region Postlaminectomy syndrome, lumbar region Spinal stenosis in cervical region Spinal stenosis, thoracic region Unspecified osteomyelitis, other specified sites Scoliosis [and kyphoscoliosis], idiopathic Other kyphoscoliosis and scoliosis Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury Closed fracture of lumbar vertebra without mention of spinal cord injury Arthrodesis status Other cervical fusion of the anterior column anterior technique Other cervical fusion of the posterior column posterior technique Dorsal and dorsolumbar fusion of the anterior column anterior technique Dorsal and dorsolumbar fusion of the posterior column, posterior technique Lumbar and lumbosacral fusion of the anterior column, anterior technique Fusion or refusion of 4-8 vertebrae Fusion or refusion of 9 or more vertebrae Page 2 of 6
Page 3 TABLE E-2 ICD-9 and 10 and CPT Codes Used to Identify Primary Outcome Measures in Humana Database Code Definition ED visits CPT-99281 CPT-99282 CPT-99283 CPT-99284 CPT-99285 Pain diagnosis on ED encounter G8918 M25561 M25562 M25569 M79609 R52 ICD-9-D-33818 ICD-9-D-71946 ICD-9-D-7295 ICD-9-D-78096 G8918 M25551 M25552 these 3 key components: a problem focused history; a problem focused examination; and straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient s and/or family s needs. Usually the presenting problem(s) are self-limited or minor. these 3 key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient s and/or family s needs. Usually the presenting problem(s) are of low to moderate severity. these 3 key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient s and/or family s needs. Usually the presenting problem(s) are of moderate severity. these 3 key components: a detailed history; a detailed examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient s and/or family s needs. Usually the presenting problem(s) are of high severity and require urgent evaluation by the physician but do not pose an immediate significant threat to life or physiologic function. these 3 key components within the constraints imposed by the urgency of the patient s clinical condition and/or mental status: a comprehensive history; a comprehensive examination; and medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient s and/or family s needs. Usually the presenting problem(s) are of high severity and pose an immediate significant threat to life or physiologic function. Other acute postprocedural pain Pain in right knee Pain in left knee Pain in unspecified knee Pain in unspecified limb Pain unspecified Other acute postoperative pain Pain in joint lower leg Pain in limb Generalized pain Other acute postprocedural pain Pain in right hip Pain in left hip Page 3 of 6
Page 4 M25559 M79609 R52 ICD-9-D-33818 ICD-9-D-33819 ICD-9-D-71945 ICD-9-D-7295 G8918 M5410 M5416 M5417 M5430 M545 M792 M79609 M961 R52 ICD-9-D-33818 ICD-9-D-33819 ICD-9-D-72283 ICD-9-D-7242 ICD-9-D-7243 ICD-9-D-7244 ICD-9-D-7245 ICD-9-D-7292 ICD-9-D-7295 ICD-9-D-72989 Fall W19XXXA Z9181 ICD-9-D-E8889 ICD-9-D-V1588 DVT/PE I2699 I82409 T8481XA ICD-9-D-41511 ICD-9-D-41519 ICD-9-D-45340 ICD-9-D-45341 ICD-9-D-45342 ICD-9-D-4539 Wound dehiscence and infection S81009A T8131XA T814XXA Pain in unspecified hip Pain in unspecified limb Pain unspecified Other acute postoperative pain Other acute pain Pain in joint pelvic region and thigh Pain in limb Other acute postprocedural pain Radiculopathy site unspecified Radiculopathy lumbar region Radiculopathy lumbosacral region Sciatica unspecified side Low back pain Neuralgia and neuritis unspecified Pain in unspecified limb Postlaminectomy syndrome not elsewhere classified Pain unspecified Other acute postoperative pain Other acute pain Postlaminectomy syndrome lumbar region Lumbago Sciatica Thoracic or lumbosacral neuritis or radiculitis unspecified Backache unspecified Neuralgia neuritis and radiculitis unspecified Pain in limb Other musculoskeletal symptoms referable to limbs Unspecified fall, initial encounter History of falling Unspecified fall History of fall Other pulmonary embolism without acute cor pulmonale Acute embolism and thrombosis of unspecified deep veins of unspecified lower extremity Embolism due to internal orthopaedic prosthetic devices implants and grafts initial encounter Iatrogenic pulmonary embolism and infarction Other pulmonary embolism and infarction Acute venous embolism and thrombosis of unspecified deep vessels of lower extremity Acute venous embolism and thrombosis of deep vessels of proximal lower extremity Acute venous embolism and thrombosis of deep vessels of distal lower extremity Other venous embolism and thrombosis of unspecified site Unspecified open wound unspecified knee initial encounter Disruption of external operation (surgical) wound not elsewhere classified initial encounter Infection following a procedure initial encounter Page 4 of 6
Page 5 T8189XA T8450XA ICD-9-D-6826 ICD-9-D-6829 ICD-9-D-6869 ICD-9-D-71106 ICD-9-D-8910 ICD-9-D-99666 ICD-9-D-99832 ICD-9-D-99859 ICD-9-D-99883 L03119 L0390 S71009A T8131XA T814XXA T8450XA ICD-9-D-6829 ICD-9-D-71105 ICD-9-D-71195 ICD-9-D-8900 ICD-9-D-8901 ICD-9-D-99666 ICD-9-D-99667 ICD-9-D-99832 ICD-9-D-99851 ICD-9-D-99859 ICD-9-D-99883 G061 L0390 S31000A T8130XA T8131XA T814XXA T847XXA ICD-9-D-3241 ICD-9-D-6829 ICD-9-D-8760 ICD-9-D-8761 ICD-9-D-99667 ICD-9-D-99830 Other complications of procedures not elsewhere classified initial encounter Infection and inflammatory reaction due to unspecified internal joint prosthesis initial encounter Cellulitis and abscess of leg except foot Cellulitis and abscess of unspecified sites Unspecified local infection of skin and subcutaneous tissue Pyogenic arthritis lower leg Open wound of knee leg [except thigh] and ankle without mention of complication Infection and inflammatory reaction due to internal joint prosthesis Disruption of external operation (surgical) wound Other postoperative infection Non-healing surgical wound Cellulitis of unspecified part of limb Cellulitis unspecified Unspecified open wound unspecified hip initial encounter Disruption of external operation (surgical) wound not elsewhere classified initial encounter Infection following a procedure initial encounter Infection and inflammatory reaction due to unspecified internal joint prosthesis initial encounter Cellulitis and abscess of unspecified sites Pyogenic arthritis pelvic region and thigh Unspecified infective arthritis pelvic region and thigh Open wound of hip and thigh without mention of complication Open wound of hip and thigh complicated Infection and inflammatory reaction due to internal joint prosthesis Infection and inflammatory reaction due to other internal orthopaedic device implant and graft Disruption of external operation (surgical) wound Infected postoperative seroma Other postoperative infection Non-healing surgical wound Intraspinal abscess and granuloma Cellulitis unspecified Unspecified open wound of lower back and pelvis without penetration into retroperitoneum initial encounter Disruption of wound unspecified initial encounter Disruption of external operation (surgical) wound not elsewhere classified initial encounter Infection following a procedure initial encounter Infection and inflammatory reaction due to other internal orthopaedic prosthetic devices implants and grafts initial encounter Intraspinal abscess Cellulitis and abscess of unspecified sites Open wound of back without mention of complication Open wound of back complicated Infection and inflammatory reaction due to other internal orthopaedic device implant and graft Disruption of wound unspecified Page 5 of 6
Page 6 ICD-9-D-99832 ICD-9-D-99851 ICD-9-D-99859 ICD-9-D-99883 Systemic infection and sepsis A419 J189 R5082 R509 ICD-9-D-0389 ICD-9-D-486 ICD-9-D-78060 ICD-9-D-78062 ICD-9-D-99591 Revision surgery 0SWC0JZ 0SWCXJZ 0SWD09Z 0SWD0JZ 0SWDXJZ ICD-9-P-0080 ICD-9-P-0081 ICD-9-P-0082 ICD-9-P-0084 ICD-9-P-8155 ICD-9-P-8456 ICD-9-P-0070 ICD-9-P-0071 ICD-9-P-0072 ICD-9-P-0073 ICD-9-P-8456 0SW90JZ 0SW9XJZ 0SWB0JZ 0SWBXJZ ICD-9-P-0302 ICD-9-P-0309 ICD-9-P-8137 ICD-9-P-8138 00JU0ZZ Disruption of external operation (surgical) wound Infected postoperative seroma Other postoperative infection Non-healing surgical wound Sepsis unspecified organism Pneumonia unspecified organism Postprocedural fever Fever unspecified Unspecified septicemia Pneumonia organism unspecified Fever unspecified Postprocedural fever Sepsis Revision of synthetic substitute in right knee joint, open approach Revision of synthetic substitute in right knee joint, external approach Revision of liner in left knee joint, open approach Revision of synthetic substitute in left knee joint, open approach Revision of synthetic substitute in left knee joint, external approach Revision of knee replacement total (all components) Revision of knee replacement tibial component Revision of knee replacement femoral component Revision of total knee replacement tibial insert (liner) Revision of knee replacement not otherwise specified Insertion or replacement of (cement) spacer Revision of hip replacement both acetabular and femoral components Revision of hip replacement acetabular component Revision of hip replacement femoral component Revision of hip replacement acetabular liner and/or femoral head only Insertion or replacement of (cement) spacer Revision of synthetic substitute in right hip joint, open approach Revision of synthetic substitute in right hip joint, external approach Revision of synthetic substitute in left hip joint, open approach Revision of synthetic substitute in left hip joint, external approach Reopening of laminectomy site Other exploration and decompression of spinal canal Refusion of lumbar and lumbosacral spine posterior column posterior technique Refusion of lumbar and lumbosacral spine anterior column posterior technique Inspection of spinal canal, open approach Page 6 of 6