Patel Arpan, Oladipo Victoria A, Kerzner Benjamin, McGlothlin Jonathan D, Levine Brett R
Loyola University Chicago Stritch School of Medicine, Maywood, IL.
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
J Arthroplasty. 2022 Jun;37(6S):S44-S49. doi: 10.1016/j.arth.2022.02.033. Epub 2022 Feb 18.
Revision total knee arthroplasties (TKA) are costly, time-intensive, and technically demanding procedures. There are concerns regarding the valuation of Current Procedural Terminology (CPT) codes and the assigned relative value units (RVU) as a potential disincentive to perform revision TKAs. This study evaluated the labor and time investment for each component-specific revision and assessed the disparities between procedural value billed and reimbursement.
A retrospective review of 154 primary and revision TKA cases were thoroughly vetted using operative notes and internal billing data. Revision TKAs were stratified by single femoral component, single tibial component, polyethylene liner only, all-component, and spacer placement for prosthetic infection. Operative time, RVUs billed, total charges, deductions, and reimbursements were recorded. Mann-Whitney U tests compared final reimbursement per minute and per RVU between revision and primary TKAs.
There were 28 primary TKAs, 11 femoral component revisions, 25 tibial component revisions, 25 liner exchanges, 37 all-component revisions, and 28 spacer placements. Revisions involving the tibial component, all-components, and placement of spacers were reimbursed less dollars per minute than primary TKAs (P < .05). Controlling for RVUs, liner exchanges and all-component revisions had fewer dollars per RVU than primary TKAs (P < .05).
As revision complexity increases, physicians face less reimbursement per minute and per RVU. With reductions set by CMS and private insurers, revisions may be financially unfavorable and lead to restrictions and access to care problems. Our data supports the need for reevaluating RVU allocation amongst revision procedures with potential updates to the CPT coding system.
全膝关节置换翻修术（TKA）成本高昂、耗时且技术要求高。人们担心现行程序编码（CPT）及其分配的相对价值单位（RVU）的估值可能会对进行TKA翻修产生潜在的抑制作用。本研究评估了每个特定组件翻修的劳动力和时间投入，并评估了计费程序价值与报销之间的差异。
使用手术记录和内部计费数据对154例初次和翻修TKA病例进行回顾性审查。TKA翻修术按单个股骨组件、单个胫骨组件、仅聚乙烯衬垫、所有组件以及用于假体感染的间隔物植入进行分层。记录手术时间、计费的RVU、总费用、扣除额和报销额。Mann-Whitney U检验比较了翻修TKA和初次TKA每分钟和每个RVU的最终报销情况。
有28例初次TKA、11例股骨组件翻修、25例胫骨组件翻修、25例衬垫更换、37例所有组件翻修和28例间隔物植入。涉及胫骨组件、所有组件和间隔物植入的翻修每分钟报销的美元数低于初次TKA（P < 0.05）。在控制RVU的情况下，衬垫更换和所有组件翻修每个RVU的美元数低于初次TKA（P < 0.05）。
随着翻修复杂性的增加，医生每分钟和每个RVU获得的报销减少。由于医疗保险和医疗补助服务中心（CMS）以及私人保险公司的报销削减，翻修在经济上可能不利，并导致医疗服务受限和获取问题。我们的数据支持重新评估翻修程序之间的RVU分配，并可能更新CPT编码系统。
