Estimated activity

— 41 episodes during 2018/19

— Age/sex std rate per 100,000 – 0.1

— Reduction opportunity based on 25th percentile of activity across CCGs: not calculated.

— Variation (age/sex std rates):

— N-fold – 4.5

— 10th percentile – 0.1

— 25th percentile – 0.1

— 50th percentile – 0.3

— 90th percentile – 0.5

 

Codes

Procedure codes

V38.2 Primary posterior interlaminar fusion of joint of lumbar spine

V38.3 Primary posterior fusion of joint of lumbar spine NEC

V38.4 Primary intertransverse fusion of joint of lumbar spine NEC

V38.5 Primary posterior interbody fusion of joint of lumbar spine

V38.6 Primary transforaminal interbody fusion of joint of lumbar spine

V40.4 Posterior instrumented fusion of lumbar spine NEC

 

Diagnosis codes

Back pain

M54.5 Low back pain

M54.9 Dorsalgia, unspecified

 

Exclusion codes:

M87.2 Osteonecrosis due to previous trauma

M40.0Postural kyphosis

M40.1Other secondary kyphosis

M40.2Other and unspecified kyphosis

M41.0Infantile idiopathic scoliosis

M41.1Juvenile idiopathic scoliosis

M41.2Other idiopathic scoliosis

M41.3Thoracogenic scoliosis

M41.4Neuromuscular scoliosis

M41.5Other secondary scoliosis

M41.8Other forms of scoliosis

M41.9Scoliosis, unspecified

M42.0 Juvenile osteochondrosis of spine

M42.1 Adult osteochondrosis of spine

M42.9 Spinal osteochondrosis, unspecified

M43.0 Spondylolysis

M43.1 Spondylolisthesis

M43.5 Other recurrent vertebral subluxation

M43.8 Other specified deforming dorsopathies

M43.9 Deforming dorsopathy, unspecified

(Note – cancer diagnoses are a global exclusion)

 

Any other criteria (e.g. patient age)

Adult (aged >=19 years)

Exclude any patients admitted as a non-elective admission

 

Will the procedure be carried out in OP or as APC?

Admitted Patient Care

 

Coding logic

Where the procedure code in dominant position is:

V38.2 OR

V38.3 OR

V38.4 OR

V38.5 OR

V38.6 OR

V40.4

AND

The diagnosis code in primary position is:

M54.5 OR

M54.9

AND

Any diagnosis code in any position is NOT:

M40.0 OR

M40.1 OR

M40.2 OR

M41.0 OR

M41.1 OR

M41.2 OR

M41.3 OR

M41.4 OR

M41.5 OR

M41.8 OR

M41.9 OR

M42.0 OR

M42.1 OR

M42.9 OR

M43.0 OR

M43.1 OR

M43.5 OR

M43.8 OR

M43.9 OR

M87.2

AND

Patient age >= 19 years

AND

APCS.Admission_Method not like (‘2%’)

SQL code

(left(der.Spell _ Dominant _ Procedure,4) like '%V38[23456]%' or
left(der.Spell _ Dominant _ Procedure,4) like '%V404%')
and der.Spell _ Primary _ Diagnosis like '%M54[59]%'
and apcs.der _ diagnosis _ all not like '%M40[012]%'
and apcs.der _ diagnosis _ all not like '%M41[01234589]%'
and apcs.der _ diagnosis _ all not like '%M42[019]%'
and apcs.der _ diagnosis _ all not like '%M43[01589]%'
and apcs.der _ diagnosis _ all not like '%M872%'
and
isnull(APCS.Age _ At _ Start _ of _ Spell _ SUS,APCS.Der _ Age _ at _ CDS _ Activity _ Date) between 19 and 120
and APCS.Admission _ Method not like ('2%')

Global cancer exclusion

APC
(apcs.der _ diagnosis _ all not like '%C[0-9] [0-9]%'
and apcs.der _ diagnosis _ all not like '%D0%'
and apcs.der _ diagnosis _ all not like '%D3[789]%'
and apcs.der _ diagnosis _ all not like '%D4[012345678]%'
or apcs.der _ diagnosis _ all IS NULL

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