1232. Systematic Review of ICD-9-CM Procedure Codes for Craniotomy/Craniectomy in Nationwide Inpatient Sample Stroke Hospitalizations

Authors: Hannah Kristen Weiss; Roxanna Garcia; Pouya Nazari, MD; Pedram Golnari, MD; Shyam Prabhakaran; Andrew Naidech; Babak Jahromi (Chicago, IL)


Large administrative datasets, such as the Nationwide Inpatient Sample (NIS), can provide substantial longitudinal, geographical, and novel clinical information; yet heterogeneity exists in analyzing this data by corresponding International Classification of Diseases, Version 9 Clinical Modification (ICD-9 CM) codes. We assessed the utilization of ICD-9 CM procedure codes for craniotomy/craniectomy in studies using NIS data for stroke care.


We performed a systematic review of PubMed for all publications that incorporated the use of the NIS to investigate craniotomy and/or craniectomy in acute ischemic stroke and non-traumatic hemorrhagic stroke hospitalizations. Eligible articles were reviewed and ICD-9 procedure codes for craniotomy/craniectomy were extracted from the included studies.


A total of 13 articles met final eligibility criteria. A total of 9 studies specified the the ICD-9 procedure code used for craniotomy/craniectomy and 4 studies included craniotomy/craniectomy in their analysis without specifying the applied code. A total of 69.2% of studies were ischemic stroke, 15.4% were hemorrhagic stroke, and 15.4% were mixed. The studies specifying the exact ICD-9 CM procedure code referenced 10 unique procedure codes, with 66.7% (n=6) studies including codes 1.25 and 1.24. Of the studies that specified procedural codes, the majority (77.8%; n=7) utilized two codes for craniotomy/craniectomy. There did not appear to be consistency across studies in selection for ICD-9-CM procedure codes.


The two most common procedural codes for craniotomy/craniectomy in NIS analysis publications include 1.24 (“Other Craniotomy”) and 1.25 (“Other Craniectomy”). There is substantial heterogeneity in selection of procedure codes. Standardizing procedure codes is necessary as its application can alter research findings and outcomes reported from the NIS database.