Physician Reimbursement for Pediatric Brachial Plexus Reconstruction
Meghan C McCullough, MD, MS1, Jordan R Wlodarczyk, MD, MS2, Laya Jacob, BS3, Korri S Hershenhouse, BS4 and Mitchel Seruya, MD4, (1)Keck School of Medicine, University of Southern California, Los Angeles, CA, (2)LAC/USC Hospital, Los Angeles, CA, (3)University of Southern California, Los Angeles, CA, (4)Keck School of Medicine of the University of Southern California, Los Angeles, CA
Introduction: Pediatric brachial plexus reconstruction and the management of nerve injuries is a rapidly advancing field within hand surgery. The procedures are marked by significant complexity requiring surgeon skill and microsurgical expertise, but the physician reimbursement rates for such procedures are not well defined. Surgeon reimbursement rates range widely among different procedures of varying difficulty within the same subspecialty and do not always correlate well to the degree of case complexity or surgical expertise required. Poor reimbursement for complex procedures such as nerve surgery can make it challenging to recruit and retain hand surgeons to perform these procedures.
Methods:CPT codes from the following surgical procedures; brachial plexus reconstruction, free tissue transfer, finger fracture fixation and skin graft surgery were collected between January 2015 and December 2019 for a single surgeon at a single pediatric institution. The top five insurance providers were analyzed. Charges, reimbursement and RVUs earned between CPT codes were compared. Secondary analysis evaluated ten of each of the studied surgical procedures and averaged the sum to compare charges, reimbursements, total adjustment, operative time, RVUs earned per case, RVUs per hour and reimbursement per hour.
Results: Average reimbursement rate, among the top five insurance providers, for brachial plexus was 34%, compared to finger fracture at 31% and skin grafts at 46%. Free tissue transfer, similar in complexity, reimbursed at 31%. RVUs per CPT code were an average of 6.01 for brachial plexus, compared to 5.25 for skin grafts, 4.81 for fracture fixation and 33.39 for free tissue transfer. RVU per hour for each CPT code were 0.61 for brachial plexus, 6.13 for skin grafts, 6.65 for fracture fixation and 2.97 for free tissue transfers. Reimbursements were an average $9.09/RVU/hour for brachial plexus, $115.83 for skin grafts, $103.76 for fracture fixation and $5.94 for free tissue transfer.
Conclusions: Hand surgeons are among the many surgical subspecialties faced with a discrepancy between physician work and financial compensation. Given both the time and technical skill necessary to perform peripheral nerve surgery and brachial plexus reconstruction, current reimbursements undervalue these procedures relative to shorter, more simple surgeries. Efforts to improve reimbursement require increased physician leadership and initiatives in understanding coding, billing, and documentation. Hand surgeons must strive to appropriately increase the value and reimbursement allocated to their work in order continue to recruit and retain talented and innovative surgeons to advance the field.
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