Emory Orthopaedics & Spine Center, Emory University School of Medicine, Atlanta, GA.
Department of Neurosurgery, Zucker School of Medicine at Hofstra, Lenox Hill Hospital, Northwell Health, NY, NY.
Spine (Phila Pa 1976). 2021 Mar 15;46(6):391-400. doi: 10.1097/BRS.0000000000003801.
Retrospective cohort study.
The aim of this study was to analyze how a Current Procedural Terminology (CPT)-based categorization method can predict cost variation in surgical spine procedures.
Neck and back disorders affect a majority of the adult population and account for tens of billions of dollars in health care spending each year. In the era of bundled payments and value-based reimbursement, it is imperative for surgeons to identify sources of cost variability across surgical spine procedures. Historically, this has been accomplished using Medicare Severity Diagnosis Related Group (MS-DRG) codes, but they utilize an overly simplistic categorization of surgical procedures. The specificity and familiarity of the CPT coding structure makes it a better option for categorizing differences in surgical decision making and technique.
Hospital billing data for patients undergoing a surgical spine procedure requiring an overnight, in-patient stay was retrospectively collected over 4 fiscal years (2012-2016) from a single health care system. Linear regression analysis was performed to assess the correlation between cost variation and: spine-specific MS-DRG codes; a novel CPT-based categorization method; and the combination of MS-DRG codes and CPT-based categorization.
There were 5020 surgical procedures were analyzed with respect to 16 different MS-DRG codes and 30 distinct CPT-based surgical categories (CSCs). Linear regression results were: MS-DRG R2 = 0.6545 (P < 0.001); CSC R2 = 0.5709 (P < 0.001); and R2 = 0.744 for the combined MS-DRG and CSC methods (P < 0.05). Median difference between the actual and predicted cost for the combined model was -$261.00, compared with -$727.50 for the CSC model and -$478.70 for the MS-DRG model.
Addition of the CPT-based categorization method to MS-DRG coding provides an enhanced method to evaluate the association between predicted and actual cost when using linear regression analysis to assess cost variation in spine surgery.Level of Evidence: 3.
回顾性队列研究。
本研究旨在分析基于当前操作术语（CPT）的分类方法如何预测手术脊柱程序的成本变化。
颈部和背部疾病影响大多数成年人口，每年的医疗保健支出达数十亿美元。在捆绑支付和基于价值的报销时代，外科医生必须确定手术脊柱程序中成本变化的来源。从历史上看，这是通过医疗保险严重程度诊断相关组（MS-DRG）代码来完成的，但是它们使用手术程序的过于简单的分类。CPT 编码结构的特异性和熟悉性使其成为分类手术决策和技术差异的更好选择。
从单个医疗保健系统中回顾性收集了 4 个财政年度（2012-2016 年）接受需要过夜住院手术的脊柱手术患者的医院计费数据。进行线性回归分析以评估成本变化与以下因素之间的相关性：脊柱特异性 MS-DRG 代码；一种新的基于 CPT 的分类方法；以及 MS-DRG 代码和基于 CPT 的分类的组合。
对 16 种不同的 MS-DRG 代码和 30 种不同的基于 CPT 的手术分类（CSC）进行了 5020 例手术程序的分析。线性回归结果为：MS-DRG R2=0.6545（P<0.001）；CSC R2=0.5709（P<0.001）；以及 MS-DRG 和 CSC 方法的 R2=0.744（P<0.05）。联合模型的实际成本与预测成本之间的中位数差异为-261.00 美元，而 CSC 模型为-727.50 美元，MS-DRG 模型为-478.70 美元。
将基于 CPT 的分类方法添加到 MS-DRG 编码中，当使用线性回归分析评估脊柱手术成本变化时，提供了一种增强的方法来评估预测成本与实际成本之间的关联。
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