Loyola University Chicago Stritch School of Medicine, Maywood, Illinois.
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
J Arthroplasty. 2022 Aug;37(8S):S807-S813. doi: 10.1016/j.arth.2022.03.025. Epub 2022 Mar 11.
Revision total hip arthroplasties (THA) are time-consuming, expensive, and technically challenging. Today's Current Procedural Terminology (CPT) codes and relative value units (RVU) may in fact disincentivize surgeons to perform revision THAs. Our study reviewed labor and time investments for each component-specific revision THA and analyzed the gap between procedural value billed and final reimbursement.
A retrospective review of 165 primary and revision THAs were validated using operative notes and billing records. We stratified revision THAs by standard CPT coding (with modifiers) as single acetabular component, single femoral component, femoral head plus polyethylene liner (head/liner) exchange, all-components, and spacer placement for infection. Operative time, RVUs, total charges, deductions, and final reimbursement data was collected. Mann-Whitney U tests studied final reimbursement per minute vs per RVU in revision and primary THAs.
Our cohort consisted of 27 primary THAs, 26 acetabular component revisions, 32 head/liner exchanges, 26 femoral component revisions, 27 all-component revisions, and 27 spacer placements. Compared to primary THAs, every revision subgroup except for head/liner exchanges were found to reimburse less per minute and all revision subgroups reimbursed less per RVU (P < .05).
Physicians face less reimbursement per minute and per RVU for revision THAs. With cuts in reimbursement set forth by Centers for Medicare and Medicaid Services (CMS) and insurers, revisions may be financially unfavorable. This ultimately will lead to an impending access to care problem in the future. Our study supports the need to re-examine the RVU allocation amongst revision THAs and evaluate changes to the Current Procedural Terminology (CPT) coding system.
翻修全髋关节置换术（THA）既耗时、昂贵，又极具技术挑战性。现行的《当前操作术语》（CPT）代码和相对价值单位（RVU）实际上可能会使外科医生不愿意进行翻修 THA。我们的研究回顾了每个特定部件翻修 THA 的劳动力和时间投入，并分析了计费程序价值与最终报销之间的差距。
使用手术记录和计费记录对 165 例初次和翻修 THA 进行回顾性审查。我们通过标准 CPT 编码（带修饰符）对翻修 THA 进行分层，包括单髋臼组件、单股骨组件、股骨头加聚乙烯衬垫（头/衬垫）置换、全组件和感染时的间隔器放置。收集手术时间、RVU、总费用、扣除额和最终报销数据。Mann-Whitney U 检验研究了翻修和初次 THA 中每分钟与每 RVU 的最终报销情况。
我们的队列包括 27 例初次 THA、26 例髋臼组件翻修、32 例头/衬垫置换、26 例股骨组件翻修、27 例全组件翻修和 27 例间隔器放置。与初次 THA 相比，除头/衬垫置换外，每个翻修亚组每分钟的报销都较少，所有翻修亚组每 RVU 的报销都较少（P<.05）。
医生对翻修 THA 的每分和每 RVU 报销较少。随着医疗保险和医疗补助服务中心（CMS）和保险公司规定的报销削减，翻修可能在财务上不利。这最终将导致未来获得医疗服务的问题。我们的研究支持需要重新审查翻修 THA 之间的 RVU 分配，并评估对当前操作术语（CPT）编码系统的更改。
