Variation in diagnostic coding of cervical decompressions in the English Hospital Episodes Statistics dataset

Retrospective cohort study.

Previous studies have identified diagnostic clinical coding inconsistencies within the Hospital Episode Statistics (HES) database for England. We aimed to explore the appropriateness of diagnostic clinical coding for cervical decompression procedures.

Extracted anonymous HES data included age, sex, frailty, deprivation, surgical procedure and diagnostic details between April 2017-March 2024. The primary outcome was the use of 'non-specific' or 'inappropriate' diagnostic clinical codes.

Data were available for 44,623 patients (54% males, n = 24,030) . The mean age was 56.5 years (SD 15.8 years). The most common diagnosis was myelopathy or radiculopathy (n = 26,764; 60%), however 32% of patients (n = 14,257) were assigned ICD-10 codes that were neither myelopathy, radiculopathy nor another appropriate code. Undergoing revision surgery (OR 1.21), and posterior surgical approach (OR 4.06) were associated with greater odds; while increasing age > 40 years, male sex (OR 0.88), emergency surgery (OR 0.55) and 3-level surgery (OR 0.74) deceased the odds of non-specific or inappropriate coding.

Inappropriate or non-specific clinical diagnostic coding information was recorded for almost a third of cervical decompression surgery in the HES patient record. We recommend the use of the most widely used codes for cervical radiculopathy (M50.1) or cervical myelopathy (M50.0).