Das Rishub K, Remy Katya, McCarty Justin C, Valerio Ian L, Austen William G, Carruthers Katherine H
From Division of Plastic and Reconstructive Surgery, Vanderbilt University Medical Center, Nashville, Tenn.
Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
Plast Reconstr Surg Glob Open. 2024 Feb 8;12(2):e5605. doi: 10.1097/GOX.0000000000005605. eCollection 2024 Feb.
For transmasculine individuals, double-incision mastectomy with free nipple grafts is the most common procedure for gender-affirming chest masculinization. However, patients report decreased sensation postoperatively. Direct coaptation of intercostal nerves to the nipple-areolar complex (NAC) is an experimental technique that may preserve postoperative sensation, yet whether reimbursements and billing codes incentivize hospital systems and surgeons to offer this procedure lacks clarity.
A retrospective cross-sectional analysis of fiscal year 2023 Medicare physician fee schedule values was performed for neurotization procedures employing Current Procedural Terminology codes specified by prior studies for neurotization of the NAC. Additionally, operative times for gender-affirming mastectomy at a single center were examined to compare efficiency between procedures with and without neurotization included.
A total of 29 encounters were included in the study, with 11 (37.9%) receiving neurotization. The mean operating time was 100.3 minutes (95% CI, 89.2-111.5) without neurotization and 154.2 minutes (95% CI, 139.9-168.4) with neurotization. In 2023, the average work relative value units (wRVUs) for neurotization procedures was 13.38. Efficiency for gender-affirming mastectomy was 0.23 wRVUs per minute without neurotization and 0.24 wRVUs per minute with neurotization, yielding a difference of 0.01 wRVUs per minute.
Neurotization of the NAC during double-incision mastectomy with free nipple grafts is an experimental technique that may improve patient sensation after surgery. Current reimbursement policy appropriately values the additional operative time associated with neurotization relative to gender-affirming mastectomy alone.
对于跨性别男性个体，游离乳头移植双切口乳房切除术是实现胸部男性化的最常见手术。然而，患者报告术后感觉减退。肋间神经与乳头乳晕复合体（NAC）直接吻合是一种可能保留术后感觉的实验性技术，但报销和计费代码是否会激励医院系统和外科医生提供该手术尚不清楚。
对2023财年医疗保险医师费用表价值进行回顾性横断面分析，以研究采用先前研究指定的用于NAC神经化的现行程序术语代码的神经化手术。此外，还检查了单一中心性别确认乳房切除术的手术时间，以比较包含和不包含神经化的手术之间的效率。
该研究共纳入29例病例，其中11例（37.9%）接受了神经化。无神经化时平均手术时间为100.3分钟（95%CI，89.2 - 111.5），有神经化时为154.2分钟（95%CI，139.9 - 168.4）。2023年，神经化手术的平均工作相对价值单位（wRVUs）为13.38。无神经化的性别确认乳房切除术效率为每分钟0.23 wRVUs，有神经化的为每分钟0.24 wRVUs，每分钟相差0.01 wRVUs。
游离乳头移植双切口乳房切除术中NAC神经化是一种可能改善术后患者感觉的实验性技术。当前报销政策合理评估了相对于单纯性别确认乳房切除术，与神经化相关的额外手术时间的价值。
