PT  - JOURNAL ARTICLE
AU  - Kai-Uwe Lewandrowski
AU  - Heber Humberto Alfaro Pachicano
AU  - Rossano Kepler Alvim Fiorelli
AU  - John C. Elfar
AU  - Stefan Landgraeber
AU  - Joachim Oertel
AU  - Stefan Hellinger
AU  - Álvaro Dowling
AU  - Paulo Sérgio Teixeira De Carvalho
AU  - Max R. F. Ramos
AU  - Helton Defino
AU  - João Paulo Bergamaschi
AU  - Paul Houle
AU  - Nicola Montemurro
AU  - Christopher Yeung
AU  - Marcelo Brito
AU  - Douglas P. Beall
AU  - Gerd Ivanic
AU  - Zhang Xifeng
AU  - Zhen-Zhou Li
AU  - Hyeun-Sung Kim
AU  - Jin-Sung L. Kim
AU  - Morgan P. Lorio
TI  - Comparative Analysis of Learning Curve, Complexity, Psychological Stress, and Work Relative Value Units for CPT 62380 Endoscopic Lumbar Spinal Decompression vs Traditional Lumbar Spine Surgeries: A Paired Rasch Survey Study
AID  - 10.14444/8594
DP  - 2024 Apr 26
TA  - International Journal of Spine Surgery
PG  - 8594
4099  - http://ijssurgery.com//content/early/2024/04/26/8594.short
4100  - http://ijssurgery.com//content/early/2024/04/26/8594.full
AB  - 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.