Comparing the Relative Value of Elective and Traumatic Hand Surgery Procedures.

BACKGROUND

The Resource-Based Relative Value Scale and its working relative value units (wRVUs) is a common model for surgeon compensation. The number of wRVUs per Current Procedural Terminology (CPT) code has been negotiated considering the degree of time, skill, and labor associated with each procedure, across all operative stages. We aimed to quantify and elucidate the rate of wRVUs per minute of elective hand surgeries as compared to traumatic hand surgeries.

METHODS

We included elective and traumatic hand surgery cases from a single academic institution between October 1, 2015, and July 1, 2023. Average operative duration and wRVU/min rates were calculated for CPT codes with at least 10 occurrences. Centers for Medicare & Medicaid Services (CMS) data were used to estimate expected values for the same procedures.

RESULTS

CPT 29848 (endoscopic carpal tunnel release) had the greatest earning rate at 0.80 wRVUs/min. CPT 26350 (flexor tendon repair, not in Zone 2) had the lowest rate at 0.09 wRVUs/min. Elective procedures had an average wRVU/min rate greater than twice the rate for traumatic procedures (0.34 vs. 0.15 wRVU/min, p<0.001). Traumatic cases had a negative correlation between wRVU/min rate and intraoperative time (r= -0.56, p=0.04).

CONCLUSION

Despite the complexity and urgency of trauma procedures, we found a significantly lower average wRVU/min rate for traumatic hand surgeries compared to elective. These results highlight the need for discussion of RVU valuation of traumatic hand surgeries.