Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois.
J Bone Joint Surg Am. 2023 Mar 15;105(6):462-467. doi: 10.2106/JBJS.22.01184. Epub 2023 Jan 19.
Total knee arthroplasty (TKA) after prior knee surgery, also known as conversion TKA (convTKA), has been associated with higher complications, resource utilization, time, and effort. The increased surgical complexity of convTKA may not be reflected by the relative value units (RVUs) assigned under the current U.S. coding guidelines. The purpose of this study was to compare the RVUs of primary TKA and convTKA and to calculate the RVU per minute to account for work effort.
The American College of Surgeons National Surgical Quality Improvement Project (NSQIP) database was analyzed for the years 2005 to 2020. Current Procedural Terminology (CPT) code 27447 alone was used to identify patients who underwent primary TKA, and 27447 plus 20680 were used to identify convTKA. After 1:1 propensity score matching, 1,600 cases were assigned to each cohort. The 2023 Medicare Physician Fee Schedule RVU-to-dollar conversion factor from the U.S. Centers for Medicare & Medicaid Services (CMS) was used to calculate RVU dollar valuations per operative time. Complication rates were compared using a multivariate logistic regression model controlling for baseline characteristics.
The mean operative time for TKA was 97.8 minutes, with a corresponding RVU per minute of 0.25, while the mean operative time for convTKA was 124.3 minutes, with an RVU per minute of 0.19 (p < 0.0001). Using the conversion factor of $33.06 per RVU, this equated to $8.11 per minute for TKA versus $6.39 per minute for convTKA. ConvTKA was associated with higher overall complication (10.9% versus 6.5%, p < 0.0001), blood transfusion (6.6% versus 3.7%, p < 0.01), reoperation (2.3% versus 0.94%, p < 0.0001), and readmission (3.7% versus 1.8%, p < 0.001) rates.
The current billing guidelines lead to lower compensation for convTKA despite its increased complexity. The longer operative time, higher complication rate, and increased resource utilization may incentivize providers to avoid performing this operation. CPT code revaluation is warranted to reflect the time and effort associated with this procedure.
Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
膝关节置换术后（TKA），也称为转换 TKA（convTKA），与更高的并发症、资源利用、时间和精力有关。当前美国编码指南下，增加的 convTKA 手术复杂性可能没有反映在相对价值单位（RVU）中。本研究的目的是比较初次 TKA 和 convTKA 的 RVU，并计算每分钟 RVU 以考虑工作强度。
对 2005 年至 2020 年的美国外科医师学会国家手术质量改进计划（NSQIP）数据库进行了分析。单独使用当前程序术语（CPT）代码 27447 来识别接受初次 TKA 的患者，而 27447 加 20680 用于识别 convTKA。经过 1:1 倾向评分匹配后，将 1600 例患者分配到每个队列中。使用美国医疗保险和医疗补助服务中心（CMS）的 2023 年医疗保险医师费用时间表 RVU 到美元转换系数来计算每手术时间的 RVU 美元估值。使用多元逻辑回归模型控制基线特征比较并发症发生率。
TKA 的平均手术时间为 97.8 分钟，对应的每分钟 RVU 为 0.25，而 convTKA 的平均手术时间为 124.3 分钟，对应的每分钟 RVU 为 0.19（p<0.0001）。使用 33.06 美元/ RVU 的转换系数，这相当于 TKA 每分钟 8.11 美元，而 convTKA 每分钟 6.39 美元。convTKA 与更高的总并发症发生率（10.9%对 6.5%，p<0.0001）、输血率（6.6%对 3.7%，p<0.01）、再次手术率（2.3%对 0.94%，p<0.0001）和再入院率（3.7%对 1.8%，p<0.001）相关。
尽管 convTKA 更复杂，但当前的计费指南导致其补偿较低。较长的手术时间、较高的并发症发生率和增加的资源利用可能会促使提供者避免进行该手术。需要重新评估 CPT 代码以反映与该程序相关的时间和精力。
治疗性三级。有关证据水平的完整描述，请参阅作者说明。
