Abstract
Background 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.
Methods 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.
Results 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.
Conclusion 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).
Clinical Relevance This study provides an updated reimbursement recommendation for endoscopic spine surgery.
Level of Evidence Level 3.
- CPT® code 62380
- RUC
- Rasch methodology
- endoscopic surgery
- learning curve
- difficulty
- psychological stress
- work effort
Footnotes
Funding The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests There was no formal funding by private, government, or commercial funders. The participating spine centers and their authors (Center For Advanced Spine Care of Southern Arizona, Tucson, Arizona; Desert Institute of Spine Care, Phoenix, Arizona; Department of Orthopedics, Fundación Universitaria Sanitas, Bogotá, D.C., Colombia; Department of Neurosurgery, Orthopedics and Thoracic Surgery at Hospital Universitário Gaffre e Guinle, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Department of Orthopedic Surgery USP, Riberao Preto Brazil, Universitätsklinikum des Saarlandes, Klinik für Orthopädie and Neurochirurgie, Department of Orthopedic Surgery, Arabellaklinik, Munich, Germany, the Atualli Spine Care Clinica, Sao Paulo, Brazil; Cape Cod Health care, Hyannis, MA, USA; Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Italy; Clínica Articulare, Belem, Brazil; Comprehensive Specialty Care, Clinical Radiology of Oklahoma, Department of Orthopedics, First Medical Center, PLA General Hospital, Beijing; Spinartus Hospital Chungdam, Korea; Department of Neurosurgery, Seoul; St. Mary’s Hospital, College of Medicine, The Catholic University of Korea) volunteered their time and internal resources to support the design and conduction of this research study. All authors aided in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results. The authors declare no conflict of interest relevant to this research, and there was no personal circumstance or interest that may be perceived as inappropriately influencing the representation or interpretation of reported research results. This research was not compiled to enrich anyone. It was merely intended to advance the understanding of the learning curve, difficulty, psychological intensity, and estimated work relative value units of endoscopic lumbar spinal decompression surgery in comparison to other common lumbar spine surgeries.
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