Fondren Orthopedic Group, 7401 Main Street, Houston, TX 77030. E-mail address:
University of Texas Medical School at Houston, 6431 Fannin, Houston, TX 77030. E-mail address:
J Bone Joint Surg Am. 2014 Sep 17;96(18):e161. doi: 10.2106/JBJS.M.01288.
The relative value units (RVUs) of the International Classification of Diseases, Ninth Revision (ICD-9) codes 29880 (partial medial and lateral meniscectomy) and 29881 (partial medial or lateral meniscectomy) were decreased from 2011 to 2012, and codes 29877 (debridement or shaving articular cartilage) and G0289 (debridement of articular cartilage or removal of foreign/loose body in a separate compartment) were bundled with codes 29880 and 29881. Our goal was to quantify the decrease in physician reimbursement in 2012 and to determine if there was an increase in the use of codes 29875 (limited synovectomy), 29876 (major synovectomy), and 29879 (abrasion arthroplasty or microfracture).
We analyzed a structured query language database for ICD-9 coding and third-party reimbursement of a large group practice. All knee arthroscopy cases were identified, and codes 29880, 29881, and 29877 were specifically assessed and compared between the years 2011 and 2012. The data were analyzed for number of cases, changes in code utilization, reimbursement per individual code and combinations of codes, and change in Medicare reimbursement between years. Statistical analyses were performed with chi-square tests to determine the difference in cases per year, and independent t tests were used to evaluate differences in reimbursement rates by insurance provider per year.
Mean surgeon third-party reimbursement for code 29880 decreased from $734.33 in 2011 to $630.40 in 2012 and from $709.17 to $639.18 for code 29881. Comparing the combination of codes 29880/29877 in 2011 to 29880 in 2012, mean reimbursement decreased from $995.07 to $630.40 (-36.65%, p < 0.001); 29881/29877 in 2011 to 29881 in 2012 (-37.39%, p < 0.001) had a similar decrease. Mean Medicare reimbursement decreased from $749.58 for 29880/29877 in 2011 to $532.71 for 29880 in 2012 and from $704.11 for 29881/29877 in 2011 to $527.04 for 29881 in 2012. When referenced to the total number of knee arthroscopy cases each year, overall use of code 29877 decreased from 2710 times in 2011 to 348 times in 2012 (-28.12%). In 2012, the use of code 29875 increased from 247 to 467 times (5.25%), the use of code 29876 increased from 852 to 874 times (4.88%), and the use of code 29879 increased from 119 to 143 times (1.06%).
Third-party reimbursement rates for cases in 2011 dropped by over 35% for similar cases in 2012. The percentage drop in Medicare payment has been similar to other payers, but the absolute reimbursements are lower. Codes 29875, 29876, and 29879 were used more often in 2012, but the absolute numbers do not balance the decrease in use of code 29877.
国际疾病分类第 9 版（ICD-9）代码 29880（部分内侧和外侧半月板切除术）和 29881（部分内侧或外侧半月板切除术）的相对价值单位（RVUs）从 2011 年降至 2012 年，并且代码 29877（关节软骨清创术或刮除术）和 G0289（关节软骨清创术或单独间隔内异物/游离体去除）与代码 29880 和 29881 捆绑在一起。我们的目标是量化 2012 年医生报酬的减少，并确定代码 29875（有限滑膜切除术）、29876（主要滑膜切除术）和 29879（磨蚀性关节成形术或微骨折术）的使用是否增加。
我们使用结构化查询语言数据库分析了一家大型实践的 ICD-9 编码和第三方报销情况。确定了所有膝关节镜检查病例，并专门评估了 2011 年和 2012 年之间的代码 29880、29881 和 29877，并进行了比较。对病例数量、代码使用变化、每个代码和代码组合的报销情况以及 Medicare 报销年度变化进行了数据分析。采用卡方检验比较每年的病例数差异，采用独立 t 检验评估每年不同保险提供者的报销率差异。
2011 年代码 29880 的外科医生第三方报销平均为 734.33 美元，2012 年降至 630.40 美元，代码 29881 从 709.17 美元降至 639.18 美元。将 2011 年的代码 29880/29877 与 2012 年的代码 29880 进行比较，平均报销额从 995.07 美元降至 630.40 美元（下降 36.65%，p<0.001）；2011 年的代码 29881/29877 与 2012 年的代码 29881 相比（下降 37.39%，p<0.001）也有类似的下降。2011 年代码 29880/29877 的医疗保险平均报销额从 749.58 美元降至 2012 年的 532.71 美元，代码 29881/29877 从 704.11 美元降至 527.04 美元。当参考每年膝关节镜检查的总病例数时，代码 29877 的总体使用量从 2011 年的 2710 次降至 2012 年的 348 次（下降 28.12%）。2012 年，代码 29875 的使用量从 247 次增加到 467 次（增加 5.25%），代码 29876 的使用量从 852 次增加到 874 次（增加 4.88%），代码 29879 的使用量从 119 次增加到 143 次（增加 1.06%）。
2011 年类似病例的第三方报销率在 2012 年下降超过 35%。医疗保险支付的降幅与其他支付者相似，但绝对报销额较低。2012 年代码 29875、29876 和 29879 的使用频率更高，但绝对数量并未平衡代码 29877 使用量减少的情况。
