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Singh V, Jolissaint JE, Kohler JG, Goh MH, Chen AF, Bedard NA, Springer BD, Schwarzkopf R. Precision or Pitfall? Evaluating the Accuracy of ICD-10 Coding for Cemented Total Hip Arthroplasty: A Multicenter Study. J Bone Joint Surg Am 2024; 106:56-61. [PMID: 37973050 DOI: 10.2106/jbjs.23.00325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND The International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Procedure Coding System (ICD-10-PCS) was adopted in the U.S. in 2015. Proponents of the ICD-10-PCS have stated that its granularity allows for a more accurate representation of the types of procedures performed by including laterality, joint designation, and more detailed procedural data. However, other researchers have expressed concern that the increased number of codes adds further complexity that leads to inaccurate and inconsistent coding, rendering registry and research data based on ICD-10-PCS codes invalid and inaccurate. We aimed to determine the accuracy of the ICD-10-PCS for identifying cemented fixation in primary total hip arthroplasty (THA). METHODS We retrospectively reviewed all cemented primary THAs performed at 4 geographically diverse, academic medical centers between October 2015 and October 2020. Cemented fixation was identified from the ICD-10-PCS coding for each procedure. The accuracy of an ICD-10-PCS code relative to the surgical record was determined by postoperative radiograph and chart review, and cross-referencing with institution-level coding published by the American Joint Replacement Registry (AJRR) was also performed. RESULTS A total of 552 cemented THA cases were identified within the study period, of which 452 (81.9%) were correctly coded as cemented with the ICD-10-PCS. The proportion of cases that were correctly coded was 187 of 260 (72%) at Institution A, 158 of 185 (85%) at Institution B, 35 of 35 (100%) at Institution C, and 72 of 72 (100%) at Institution D. Of the 480 identified cemented THA cases at 3 of the 4 institutions, 403 (84%) were correctly reported as cemented to the AJRR (Institution A, 185 of 260 cases [71%]; Institution B, 185 of 185 [100%]; and Institution C, 33 of 35 [94%]). Lastly, of these 480 identified cemented THA cases, 317 (66%) were both correctly coded with the ICD-10-PCS and correctly reported as cemented to the AJRR. CONCLUSIONS Our findings revealed existing discrepancies within multiple institutional data sets, which may lead to inaccurate reporting by the AJRR and other registries that rely on ICD-10-PCS coding. Caution should be exercised when utilizing ICD-10 procedural data to evaluate specific details from administrative claims databases as these inaccuracies present inherent challenges to data validity and interpretation.
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Affiliation(s)
- Vivek Singh
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
- Department of Orthopaedic Surgery, Dignity Health - St. Joseph's Medical Center, Stockton, California
| | - Josef E Jolissaint
- OrthoCarolina Hip and Knee Center, Atrium Health Musculoskeletal Institute, Carolinas Medical Center, Charlotte, North Carolina
| | - James G Kohler
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa
| | - Megan H Goh
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nicholas A Bedard
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Bryan D Springer
- OrthoCarolina Hip and Knee Center, Atrium Health Musculoskeletal Institute, Carolinas Medical Center, Charlotte, North Carolina
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
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Snelling PJ, Jones P, Gillespie A, Bade D, Keijzers G, Ware RS. Point-of-Care Ultrasound Fracture-Physis Distance Association with Salter-Harris II Fractures of the Distal Radius in Children: The "POCUS 1-cm Rule". ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:520-526. [PMID: 36333153 DOI: 10.1016/j.ultrasmedbio.2022.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 09/21/2022] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
Salter-Harris II fractures of the distal radius can result in serious complications. The aim of this study was to measure the fracture-physis distance using point-of-care ultrasound (POCUS) to determine whether a certain distance is associated with Salter-Harris II fractures, compared with other fracture types, in a cohort of children with X-ray-identified distal radius fractures. Participants were from a parent diagnostic study conducted in an Australian tertiary pediatric emergency department, which prospectively evaluated the diagnosis of pediatric distal forearm fractures using POCUS compared against X-ray. Nurse practitioners, who underwent 2 h of training, administered a six-view POCUS protocol in clinically non-angulated pediatric forearm injuries prior to X-ray. This was a secondary analysis of data from the parent study. The 122 participants with X-ray-identified distal radius fractures from the parent study had their POCUS images interpreted by two emergency physician sonologists, who measured the fracture-physis distance. The median and maximum fracture-physis distances for Salter-Harris II fractures (n = 19) were 8.00 and 9.85 mm, whereas minimum and median distances for incomplete fractures (n = 22) were 10.20 and 15.98 mm, and those for complete fractures (n = 9) were 10.85 and 12.85 mm. Buckle fracture (n = 72) distances ranged from 4.35 to 26.55 mm, with a median of 13.65 mm. In children diagnosed with a distal radius fracture on X-ray, a fracture-physis distance cutoff of 1 cm differentiated Salter-Harris II fractures from other cortical breach fracture types, but not buckle fractures. Although this exploratory study suggests the "POCUS 1-cm rule" could be used as a secondary sign to augment the diagnosis of Salter-Harris II distal radius fractures using POCUS, further research is required to validate this measurement prospectively.
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Affiliation(s)
- Peter J Snelling
- School of Medicine and Dentistry and Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia; Emergency Department, Gold Coast University Hospital, Southport, Queensland, Australia; Sonography Innovation and Research (Sonar) Group, Queensland, Australia; Child Health Research Centre, University of Queensland, South Brisbane, Queensland, Australia; Queensland Children's Hospital, South Brisbane, Queensland, Australia.
| | - Philip Jones
- School of Medicine and Dentistry and Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia; Emergency Department, Gold Coast University Hospital, Southport, Queensland, Australia; Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Alan Gillespie
- Emergency Department, Gold Coast University Hospital, Southport, Queensland, Australia
| | - David Bade
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Gerben Keijzers
- School of Medicine and Dentistry and Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia; Emergency Department, Gold Coast University Hospital, Southport, Queensland, Australia; Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Robert S Ware
- School of Medicine and Dentistry and Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
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Waelti SL, Markart S, Willems EP, Fischer T, Dietrich TJ, Ditchfield M, Matissek C, Krebs T. Radiographic features of magnesium-based bioabsorbable screw resorption in paediatric fractures. Pediatr Radiol 2022; 52:2368-2376. [PMID: 35606529 DOI: 10.1007/s00247-022-05383-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/28/2022] [Accepted: 04/13/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Resorption of magnesium-based alloy bioabsorbable screws produces hydrogen gas, which can be mistaken as a sign of infection and may affect the physis or fixed bone fragment. OBJECTIVE We evaluated the temporal and spatial occurrence of gas and the occurrence of a breakage of the fixed bone fragment or screw following magnesium screw fixation. MATERIALS AND METHODS Radiographs of paediatric patients treated with magnesium screws were retrospectively reviewed. Temporal occurrence and distribution of gas in the bone, the physis and soft tissues, breakage of the screw or fixed bone fragment and joint effusion were assessed. RESULTS One hundred and three radiographs in 35 paediatric patients were reviewed (mean age: 10.6 years). Follow-up ranged from 1 to 730 days. Gas in the bone increases up to week 5, remains constant up to week 16 and then decreases. Gas in soft tissues, intra-articular gas and joint effusions gradually reduce over time. In 1/23 (4.3%) patients with an open physis, gas intrusion into the physis occurred. Breakage of the bone fragment fixated by the screw was observed in 4/35 (11.4%) patients within the first 6 weeks. Screw breakage was observed in 16/35 (45.7%) patients, with a median time to first detection of 300 days. CONCLUSION Gas bubbles in bone and soft tissue are normal findings in the context of screw resorption and should not be confused with soft-tissue infection or osteomyelitis. Gas is rarely visible in the physis. Breakage of the fixed bone fragment and/or screw can occur.
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Affiliation(s)
- Stephan L Waelti
- Department of Radiology and Nuclear Medicine, Children's Hospital of Eastern Switzerland, Claudiusstrasse 6, 9006, St. Gallen, Switzerland.
- Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
| | - Stefan Markart
- Department of Radiology and Nuclear Medicine, Children's Hospital of Eastern Switzerland, Claudiusstrasse 6, 9006, St. Gallen, Switzerland
- Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Erik P Willems
- Clinical Trials Unit, Biostatistics, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Tim Fischer
- Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Tobias J Dietrich
- Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Michael Ditchfield
- Department of Diagnostic Imaging, Monash Children's Hospital, Monash Health, Clayton, Australia
| | - Christoph Matissek
- Department of Paediatric Surgery, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Thomas Krebs
- Department of Paediatric Surgery, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
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Fuchs JR, Gibly RF, Erickson CB, Thomas SM, Hadley Miller N, Payne KA. Analysis of Physeal Fractures from the United States National Trauma Data Bank. CHILDREN 2022; 9:children9060914. [PMID: 35740851 PMCID: PMC9221780 DOI: 10.3390/children9060914] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 01/08/2023]
Abstract
Background: Pediatric long-bone physeal fractures can lead to growth deformities. Previous studies have reported that physeal fractures make up 18–30% of total fractures. This study aimed to characterize physeal fractures with respect to sex, age, anatomic location, and Salter–Harris (SH) classification from a current multicenter national database. Methods: A retrospective cohort study was performed using the 2016 United States National Trauma Data Bank (NTDB). Patients ≤ 18 years of age with a fracture of the humerus, radius, ulna, femur, tibia, or fibula were included. Results: The NTDB captured 132,018 patients and 58,015 total fractures. Physeal fractures made up 5.7% (3291) of all long-bone fractures, with males accounting for 71.0% (2338). Lower extremity physeal injuries comprised 58.6% (1929) of all physeal fractures. The most common site of physeal injury was the tibia comprising 31.8% (1047), 73.9% (774) of which were distal tibia fractures. Physeal fractures were greatest at 11 years of age for females and 14 years of age for males. Most fractures were SH Type II fractures. Discussion and Conclusions: Our analysis indicates that 5.7% of pediatric long-bone fractures involved the physis, with the distal tibia being the most common. These findings suggest a lower incidence of physeal fractures than previous studies and warrant further investigation.
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Affiliation(s)
- Joseph R. Fuchs
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (J.R.F.); (R.F.G.); (C.B.E.); (S.M.T.); (N.H.M.)
- McGaw Medical Center, Northwestern University, Chicago, IL 60611, USA
| | - Romie F. Gibly
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (J.R.F.); (R.F.G.); (C.B.E.); (S.M.T.); (N.H.M.)
- Division of Orthopaedic Surgery and Sports Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
| | - Christopher B. Erickson
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (J.R.F.); (R.F.G.); (C.B.E.); (S.M.T.); (N.H.M.)
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Stacey M. Thomas
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (J.R.F.); (R.F.G.); (C.B.E.); (S.M.T.); (N.H.M.)
| | - Nancy Hadley Miller
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (J.R.F.); (R.F.G.); (C.B.E.); (S.M.T.); (N.H.M.)
- Musculoskeletal Research Center, Children’s Hospital Colorado, Aurora, CO 80045, USA
| | - Karin A. Payne
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (J.R.F.); (R.F.G.); (C.B.E.); (S.M.T.); (N.H.M.)
- Gates Center for Regenerative Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Correspondence:
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Clinical utility and economic impact of routine delayed follow-up radiographs in children with uncomplicated distal radius Salter-Harris 2 fractures. Pediatr Radiol 2021; 51:1231-1236. [PMID: 33544191 DOI: 10.1007/s00247-021-04967-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 11/03/2020] [Accepted: 01/07/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Salter-Harris 2 fractures of the distal radius are common in pediatrics. Children with these fractures have a theoretical risk of developing a physeal bridge with subsequent growth disturbance. OBJECTIVE The purpose of this study was to investigate the clinical utility and economic impact of obtaining routine delayed radiographs in asymptomatic patients with uncomplicated Salter-Harris 2 fractures of the distal radius. MATERIALS AND METHODS Radiology records were searched retrospectively between Jan. 1, 2016, and Jan. 1, 2018, to identify patients with an acute Salter-Harris type 2 fracture of the distal radius and delayed wrist radiography 3 to 8 months after the injury. Exclusion criteria included distal radius surgery, clinical symptoms, secondary wrist trauma or a history of infection. The financial cost associated with follow-up imaging was determined based on standard charges associated with wrist/forearm radiography, wrist magnetic resonance imaging (MRI) and orthopedic clinical care. RESULTS A total of 381 children with Salter-Harris 2 fractures of the distal radius and delayed radiographs were identified, 56% male (ages 1-18 years, mean: 9.8 years). Four children were excluded because of surgical intervention or clinical symptoms to the same wrist resulting in 377 subjects. There were five confirmed positive cases (1.3%) of distal radius physeal bridge formation, with four cases confirmed on MRI and one case confirmed clinically and radiographically. Based on routine institutional charges for the wrist/forearm radiographs and orthopedic clinic visits, the total billed charges for the 377 patients would equal $245,804, or $49,161 in billed charges per identified physeal bridge. Only three of the five positive cases of confirmed physeal bridge went on to surgical treatment. The billed charges per identified physeal bridge requiring surgery were $81,935. CONCLUSION In asymptomatic children with uncomplicated Salter-Harris 2 fractures of the distal radius, detection of a physeal bridge on delayed radiographs is rare. The financial burden of routine delayed follow-up in asymptomatic patients, a common clinical practice, is an important consideration.
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