What's fair pay for lumbar endoscopy?
- business3321
- Jul 4, 2024
- 3 min read
Since January 1, 2017, a new Category I Current Procedural Terminology (CPT®) code, 62380, was introduced for endoscopic lumbar spinal decompression. This code covers endoscopic, percutaneous, or minimally invasive interventions, including laminotomy, partial facetectomy, foraminotomy, discectomy, and resection of herniated intervertebral discs within the lumbar region. The diagnostic protocol for identifying lumbar pain causes has been endorsed by 14 global spine surgeon societies.
However, the American Medical Association's (AMA) Specialty Society Relative Value Scale Update Committee (RUC) has not recommended any work relative value units (RVUs) for CPT® code 62380 to the Centers for Medicare and Medicaid Services (CMS). This study aims to objectively measure the learning curve, psychological stress, and work effort required for endoscopic lumbar decompression compared to other common lumbar spinal surgeries. Over 500 surgeons were surveyed using the Rasch methodology to provide this assessment.
Surgeon Survey
An online survey was conducted targeting 542 surgeons. It focused on a clinical case of a patient with sciatica-type leg pain due to neurogenic claudication. The survey aimed to gather insights on the learning curve, mental demand, and workload of endoscopic lumbar decompression relative to other lumbar surgeries. The survey included questions about practice environment, postgraduate education, and experience with endoscopic procedures.
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
The Rasch Methodology
The Rasch model, a psychometric tool used to analyze categorical data from assessments or questionnaires, was employed. The model evaluated responses based on the balance between the respondent’s abilities and the item’s difficulty. Surgeons indicated which procedure required more effort in paired comparisons of CPT® codes. Logistic regression methods estimated the probability of each procedure being more challenging, providing difficulty, intensity, and work effort scores.
Work-Related RVU Regression Analysis
The Rasch analysis estimated the difficulty/work effort scores for various CPT® codes. These scores were regressed on existing RVUs to generate a regression line, estimating the RVUs for CPT® code 62380.
Results
A total of 322 surgeons participated in the survey, with 150 providing complete responses. The respondents were primarily neurosurgeons (43.3%) and orthopedic specialists (38.6%). The Rasch analysis showed that the learning curve for lumbar endoscopic decompression surgery is steeper and more complex than traditional translaminar lumbar decompression surgeries and some fusion procedures. The psychological stress, mental, and work effort associated with endoscopic lumbar decompression were also perceived to be higher.
The Rasch analysis provided a detailed assessment of the learning curve, psychological stress, and work effort. The estimated RVU for CPT® code 62380 was 18.2464, which is higher than several traditional lumbar surgery codes.
Discussion
The results underline the complexity and higher work effort required for lumbar endoscopic decompression surgery compared to traditional lumbar surgeries. This finding highlights the need for accurate valuation of CPT® code 62380. The Rasch methodology proved effective in assessing these aspects, providing a reliable basis for RVU recommendations.
Summary
The Rasch analysis suggests that the value assigned to endoscopic lumbar decompression surgery should surpass that of standard lumbar surgeries such as laminectomy and microsurgical discectomy. These findings are relevant for discussions regarding credentialing, training, and appropriate RVU assignment for spine surgeons performing endoscopic procedures. Future analysis may be necessary as technology advances and surgeons acquire higher skill levels in performing more intricate endoscopic procedures.
Authors:
Kai-Uwe Lewandrowski, MD, Heber Humberto Alfaro Pachicano, MD, Rossano Kepler Alvim Fiorelli, MD, John C Elfar, MD, Stefan Landgraeber, MD, Joachim Oertel, MD, Stefan Hellinger, MD, Álvaro Dowling, MD, Paulo Sérgio Teixeira De Carvalho,MD, PhD, Max R.F. Ramos, MD, PhD, Helton Defino, MD, PhD, João Paulo Bergamaschi, MD, Paul Houle, MD, Nicola Montemurro, MD, PhD, Christopher Yeung, MD, Marcelo Brito, MD, Douglas P. Beall, MD, Gerd Ivanic, MD, Zhang Xifeng, MD, Zhen-Zhou Li, MD, Hyeun-Sung Kim, MD, PhD, Jin-Sung L. Kim, MD, PhD, and Morgan P Lorio, MD, FACS
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