Cyriac Mathew, Delvadia Bela P, Winter Julianna E, Budin Jacob S, Lee Olivia C, Sherman William F
Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA.
J Spine Surg. 2024 Dec 20;10(4):627-634. doi: 10.21037/jss-24-60. Epub 2024 Nov 18.
Surgical fusion of the sacroiliac (SI) joint is often performed to manage chronic lower back or buttock pain. When Current Procedural Terminology (CPT) codes were introduced, SI joint fusion procedures were done primarily by orthopaedic surgeons and neurosurgeons. The purpose of this study was to examine the utilization of SI joint fusion CPT codes by physician specialty over time.
A retrospective cohort study was conducted using the PearlDiver database. The database was queried using CPT codes to identify patients who underwent SI joint fusion via percutaneous, open, or trauma codes. Specialties queried included surgical specialties (orthopaedic surgery and neurosurgery) and non-surgical specialties [physical medicine and rehabilitation (PM&R), neurology, anesthesiology, pain medicine]. Total number and number per year of SI joint fusion procedures were identified for each specialty group. Trends of SI fusion billing for the years 2015 to 2021 were compared between surgical specialties and non-surgical specialties.
Comparing 2015 and 2021, the SI fusion codes submitted across all three groups (percutaneous, open, and trauma) increased for non-surgical specialties compared to surgical specialties. Between 2015 and 2021, the total number of percutaneous procedures submitted by all specialties increased by 294%, while the number of procedures being submitted by non-surgical specialties increased by 25,050%.
Our study demonstrated how quickly and to what degree the procedure market can react to higher work relative value unit (RVU) value codes. Despite requiring less overall time and utilizing an intra-articular rather than a transfixing approach, non-surgical specialties submitted the same CPT code as surgical specialties performing the transfixing procedure at an increasing rate during the study period. With the introduction of new technologies to perform SI fixation and a new code to capture the intra-articular procedure, future studies could examine whether the number of SI fusion procedures performed by the various physician specialties stabilizes over time.
骶髂（SI）关节手术融合常用于治疗慢性下背部或臀部疼痛。引入现行程序术语（CPT）编码时，SI关节融合手术主要由骨科医生和神经外科医生进行。本研究的目的是考察不同专业医生随时间推移对SI关节融合CPT编码的使用情况。
使用PearlDiver数据库进行一项回顾性队列研究。通过CPT编码查询数据库，以识别经皮、开放或创伤编码进行SI关节融合的患者。查询的专业包括外科专业（骨科手术和神经外科）和非外科专业[物理医学与康复（PM&R）、神经病学、麻醉学、疼痛医学]。确定每个专业组SI关节融合手术的总数及每年的手术数量。比较2015年至2021年外科专业和非外科专业SI融合计费趋势。
与2015年相比，2021年非外科专业提交的所有三组（经皮、开放和创伤）的SI融合编码数量相对于外科专业有所增加。2015年至2021年，所有专业提交的经皮手术总数增加了294%，而非外科专业提交的手术数量增加了25050%。
我们的研究表明手术市场对更高工作相对价值单位（RVU）价值编码的反应速度有多快以及程度如何。尽管总体所需时间较少且采用关节内而非贯穿固定方法，但在研究期间，非外科专业提交与进行贯穿固定手术的外科专业相同CPT编码的比例在不断增加。随着用于SI固定的新技术的引入以及用于记录关节内手术的新编码的出现，未来研究可以考察不同专业医生进行的SI融合手术数量是否会随时间稳定下来。
