Lewandrowski Kai-Uwe, Alfaro Pachicano Heber Humberto, Alvim Fiorelli Rossano Kepler, Elfar John C, Landgraeber Stefan, Oertel Joachim, Hellinger Stefan, Dowling Álvaro, De Carvalho Paulo Sérgio Teixeira, Ramos Max R F, Defino Helton, Bergamaschi João Paulo, Houle Paul, Montemurro Nicola, Yeung Christopher, Brito Marcelo, Beall Douglas P, Ivanic Gerd, Xifeng Zhang, Li Zhen-Zhou, Kim Hyeun-Sung, Kim Jin-Sung L, Lorio Morgan P
Division Personalized Pain Research and Education, Center for Advanced Spine Care of Southern Arizona, Tucson, AZ, USA
Department of Orthopaedics, Full Professor, Fundación Universitaria Sanitas, Bogotá, D.C., Colombia.
Int J Spine Surg. 2024 May 6;18(2):138-151. doi: 10.14444/8594.
Effective 1 January 2017, single-level endoscopic lumbar discectomy received a Category I Current Procedural Terminology (CPT) code 62380. However, no work relative value units (RVUs) are currently assigned to the procedure. An international team of endoscopic spine surgeons conducted a study, endorsed by several spine societies, analyzing the learning curve, difficulty, psychological intensity, and estimated work RVUs of endoscopic lumbar spinal decompression compared with other common lumbar spine surgeries.
A survey comparing CPT 62380 to 10 other comparator CPT codes reflective of common spine surgeries was developed to assess the work RVUs in terms of learning curve, difficulty, psychological intensity, and work effort using a paired Rasch method.
The survey was sent to 542 spine specialists. Of 322 respondents, 150 completed the survey for a 43.1% completion rate. Rasch analysis of the submitted responses statistically corroborated common knowledge that the learning curve with lumbar endoscopic spinal surgery is steeper and more complex than with traditional translaminar lumbar decompression surgeries. It also showed that the psychological stress and mental and work effort with the lumbar endoscopic decompression surgery were perceived to be higher by responding spine surgeons compared with posterior comparator decompression and fusion surgeries and even posterior interbody and posterolateral fusion surgeries. The regression analysis of work effort vs procedural difficulty showed the real-world evaluation of the lumbar endoscopic decompression surgery described in CPT code 62380 with a calculated work RVU of 18.2464.
The Rasch analysis suggested the valuation for the endoscopic lumbar decompression surgery should be higher than for standard lumbar surgeries: 111.1% of the laminectomy with exploration and/or decompression of spinal cord and/or cauda equina (CPT 63005), 118.71% of the laminectomy code (CPT 63047), which includes foraminotomy and facetectomy, 152.1% of the hemilaminectomy code (CPT 63030), and 259.55% of the interlaminar or interspinous process stabilization/distraction without decompression code (CPT 22869). This research methodology was endorsed by the Interamerican Society for Minimally Invasive Spine Surgery (SICCMI), the Mexican Society of Spinal Surgeons (AMCICO), the International Society For Minimally Invasive Spine Surgery (ISMISS), the Brazilian Spine Society (SBC), the Society for Minimally Invasive Spine Surgery (SMISS), the Korean Minimally Invasive Spine Surgery (KOMISS), and the International Society for the Advancement of Spine Surgery (ISASS).
This study provides an updated reimbursement recommendation for endoscopic spine surgery.
Level 3.
自2017年1月1日起，单节段内镜下腰椎间盘切除术被赋予了一级现行手术操作术语（CPT）编码62380。然而，目前该手术尚无工作相对价值单位（RVU）。一个由内镜脊柱外科医生组成的国际团队开展了一项研究，该研究得到了多个脊柱协会的认可，旨在分析内镜下腰椎减压术与其他常见腰椎手术相比的学习曲线、难度、心理强度以及估计的工作RVU。
开展了一项调查，将CPT 62380与反映常见脊柱手术的其他10个对照CPT编码进行比较，采用配对Rasch方法从学习曲线、难度、心理强度和工作努力程度方面评估工作RVU。
该调查发送给了542名脊柱专科医生。在322名受访者中，150人完成了调查，完成率为43.1%。对提交的回复进行的Rasch分析从统计学上证实了一个常识，即腰椎内镜脊柱手术的学习曲线比传统经椎板腰椎减压手术更陡峭、更复杂。该分析还表明，与后路对照减压和融合手术甚至后路椎间融合和后外侧融合手术相比，参与调查的脊柱外科医生认为腰椎内镜减压手术的心理压力以及脑力和体力消耗更大。工作努力程度与手术难度的回归分析显示，CPT编码62380所描述的腰椎内镜减压手术在实际操作中的评估工作RVU为18.2464。
Rasch分析表明，内镜下腰椎减压手术的估值应高于标准腰椎手术：脊髓和/或马尾神经探查和/或减压的椎板切除术（CPT 项目63005）的111.1%，包括椎间孔切开术和小关节切除术的椎板切除术编码（CPT 63047）的118.71%，半椎板切除术编码（CPT 63030）的152.1%，以及无减压的椎间隙或棘突间稳定/撑开编码（CPT 22869）的259.55%。这种研究方法得到了美洲微创脊柱外科学会（SICCMI）、墨西哥脊柱外科学会（AMCICO）、国际微创脊柱外科学会（ISMISS）、巴西脊柱协会（SBC）、微创脊柱外科学会（SMISS）、韩国微创脊柱外科学会（KOMISS）以及国际脊柱手术促进会（ISASS）的认可。
本研究为内镜脊柱手术提供了最新的报销建议。
3级。
