Financial Impact of Third-Party Reimbursement Due to Changes in the Definition of ICD-9 Arthroscopy Codes 29880, 29881, and 29877

Elkousy, Hussein; Heaps, Braiden M.; Overturf, Steven; Laughlin, Mitzi S.

doi:10.2106/jbjs.m.01288

Cited by 5 publications

(9 citation statements)

References 13 publications

(14 reference statements)

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“…It is unclear what drove this increase; however, it may be related to the relative value unit decrease for the 2 surgical CPT codes (29880 and 29881) used in the study. 10 …”

Section: Discussionmentioning

confidence: 99%

“…It is unclear what drove this increase; however, it may be related to the relative value unit decrease for the 2 surgical CPT codes (29880 and 29881) used in the study. 10 When compared with other surgical subspecialties, orthopaedic reimbursements have been reported to be declining at a greater rate. 11 Orthopaedic surgeons are being reimbursed less while balancing increased responsibilities tied to bundled payments, readmission penalties, and a multitude of quality metrics.…”

Section: Discussionmentioning

confidence: 99%

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Analysis of Charges and Payments for Outpatient Arthroscopic Meniscectomy From 2005 to 2014: Hospital Reimbursement Increased Steadily as Surgeon Payments Declined

LaPrade

Camp

Krych

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Charge and reimbursement trends for arthroscopic partial meniscectomies among orthopaedic surgeons, anesthesiologists, and hospital/surgery centers have not been formally analyzed, even though meniscectomies are the most commonly performed orthopaedic surgery. Purpose: To analyze Medicare charge and reimbursement trends for surgeons, anesthesiologists, and hospital/surgery centers for outpatient arthroscopic partial meniscectomies performed in the United States. Study Design: Economic and decision analysis; Level of evidence, 4. Methods: We analyzed trends in surgeon, anesthesiologist, and hospital charges and reimbursements for outpatient isolated arthroscopic partial meniscectomies from 2005 to 2014. Current Procedural Terminology codes were used to capture charge and reimbursement information using the nationally representative 5% Medicare sample. National and regional trends for charge, reimbursement, and Charlson Comorbidity Index (CCI) were evaluated using linear regression analysis. Results: A total of 31,717 patients were analyzed in this study. Charges across all groups increased significantly ( P < .001) during the 10-year study period, with an increase of 18.4% ($2754-$3262) for surgeons, 85.5% ($802-$1480) for anesthesiologists, and 116.8% ($2743-$5947) for hospitals. Surgeon reimbursements declined by 15.5% ($504-$426; P = .072) during this period. Anesthesiologist and hospital reimbursements increased significantly during by 36.5% ($133-$182; P < .001) and 28.9% ($1540-$1984; P < .001) during the 10-year study period, respectively. The annual incidence of partial meniscectomies per 10,000 database patients decreased significantly from 18.3 to 15.6 over the course of the study (14.8% decrease; P = .009), while the CCI did not change significantly ( P = .798). Conclusion: Hospital and anesthesiologist Medicare reimbursements for outpatient arthroscopic partial meniscectomies increased significantly, while surgeon reimbursements decreased. In 2005, hospitals were reimbursed 205% more ($1540 vs $504) than surgeons, and by 2014, they were reimbursed 365% more ($1984 vs $426), indicating that the gap between hospital and surgeon reimbursement is rising. Improved understanding of charge and reimbursement trends represents an opportunity for key stakeholders to improve financial alignment across the field of orthopaedics.

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“…It is unclear what drove this increase; however, it may be related to the relative value unit decrease for the 2 surgical CPT codes (29880 and 29881) used in the study. 10 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Analysis of Charges and Payments for Outpatient Arthroscopic Meniscectomy From 2005 to 2014: Hospital Reimbursement Increased Steadily as Surgeon Payments Declined

LaPrade

Camp

Krych

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…The results presented in these studies may have been impacted by the changes in reimbursement and billing practices following publication of the trial by Moseley et al In 2004, a non‐coverage determination was put forth by Medicare for the use of knee arthroscopy or debridement for knee OA [14]. While this initially may seem like it could deter the use of knee arthroscopy for degenerative conditions of the knee, a subsequent study suggested that it likely resulted in changes in coding to highlight alternative diagnoses, such as meniscal pathology rather than OA, and alternative procedures, such as synovectomy or meniscectomy rather than debridement of articular cartilage [8]. Therefore, these studies, which aimed to evaluate knee arthroscopy rates for the diagnosis of OA, may report a reduction in procedural rates that they are falsely attributing to the impact of Moseley's trial, rather than considering that it may instead reflect a change in procedural coding.…”

Section: Discussionmentioning

confidence: 99%

Trends in knee arthroscopy utilization: a gap in knowledge translation

Degen

Lebedeva

Birmingham

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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Purpose To evaluate the longitudinal trends in knee arthroscopy utilization in relation to published negative randomized controlled trials, focusing on annual rates, patient demographics and associated 30‐day post‐operative complications. Methods The American College of Surgeons National Surgical Quality Improvement Program database was queried using Current Procedural Terminology billing codes to identify arthroscopy cases between 2006 and 2016. 30‐day post‐operative complications were identified, and potential risk factors analysed using univariate and multivariate analyses. Results 68,346 patients underwent knee arthroscopy, of which 47,446 (69.5%) represented partial meniscectomies. The annual procedural rate, as a proportion of all reported cases, increased significantly from 2006 (0.3%) to 2016 (1.6%; p < 0.001), along with a significant increase in average patient age (44.3 ± 15.5 to 48.4 ± 14.5; p < 0.001). Specifically focusing on the meniscectomy cohort, average patient age significantly increased from 47.9 ± 15.1 to 50.7 ± 13.5 (p = 0.001). The overall incidence of complications was 2.0% (n = 1333), with major complications in 0.9% (n = 639) and minor complications in 1.0% (n = 701). Common complications included a return to the operating room (0.5%), deep vein thrombosis/thrombophlebitis (0.4%), and superficial infection (0.2%). Operating time > 90 min, diabetes, steroid use, ASA class 2+, and dialysis‐dependency were the predictors of overall complication rates. Conclusion Despite the publication of negative trials and new clinical practice guidelines, knee arthroscopy utilization and average patient age continue to increase. Given the high utilization, even low adverse event rates equate to substantial numbers of patients with minor and major complications. The NSQIP data show a gap in knowledge translation to clinical practice and highlight the need for improved clinical guidelines. Level of evidence Cohort study; Level III.

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“…In 2012, Medicare changed reimbursement for arthroscopic debridement by bundling code 29877 (debridement or shaving of articular cartilage) with 29880 (medial and lateral APM) and 29881 (medial or lateral APM) 29,30 . Reimbursement for meniscectomies with chondral debridement that would have been coded with 29877 has since decreased by 35%, but the impact of this coding change on the actual number of chondroplasties being performed with APM remains unknown 29 . A recent study also found that arthroscopic debridement is not cost-effective compared with nonoperative management of knee osteoarthritis 31 .…”

Section: Discussionmentioning

confidence: 99%

Patient Outcomes After Observation Versus Debridement of Unstable Chondral Lesions During Partial Meniscectomy

Bisson

Kluczynski

Wind

et al. 2017

The Journal of Bone and Joint Surgery

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Financial Impact of Third-Party Reimbursement Due to Changes in the Definition of ICD-9 Arthroscopy Codes 29880, 29881, and 29877

Cited by 5 publications

References 13 publications

Analysis of Charges and Payments for Outpatient Arthroscopic Meniscectomy From 2005 to 2014: Hospital Reimbursement Increased Steadily as Surgeon Payments Declined

Analysis of Charges and Payments for Outpatient Arthroscopic Meniscectomy From 2005 to 2014: Hospital Reimbursement Increased Steadily as Surgeon Payments Declined

Trends in knee arthroscopy utilization: a gap in knowledge translation

Patient Outcomes After Observation Versus Debridement of Unstable Chondral Lesions During Partial Meniscectomy

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