American Society for Peripheral Nerve
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Undervalued Physician Reimbursement in Peroneal Nerve Transfer Surgery
Robin Babadjouni, MD; Mitchel Seruya, MD
Cedars-Sinai Medical Center, Los Angeles, CA

Introduction: Peroneal nerve transfer surgery is a unique treatment option for patients with foot drop who would otherwise be managed with musculotendinous rebalancing solutions. This complex procedure requires surgeon skill and microsurgical expertise, however physician reimbursement rates are not well defined. Reimbursement rates range widely within peripheral nerve surgery and do not correlate to the degree of case complexity or surgical experience required. Poor reimbursement rates for such complex and creative cases in nerve transfer surgery can make it challenging to recruit and retain surgeons to perform these procedures.
Materials and Methods: Current Procedural Terminology (CPT) codes from peroneal nerve transfer and peroneal nerve decompression surgeries were collected from October 2020 to May 2022 for a single surgeon at a single tertiary institution. The top 8 insurance providers were analyzed. Charges, reimbursement, relative value units (RVUs) and RVUs per hour earned for CPT codes were analyzed comparing peroneal decompression to peroneal nerve transfer surgery.
Results: A total of 17 and 23 patients were analyzed for peroneal decompression and peroneal nerve transfer surgery, respectively. Average percent of reimbursement, among the top 8 insurance providers, for peroneal decompression was 35% compared to 36% for peroneal nerve transfer surgery. Average sum of payments was $1614 for peroneal decompression and $3423 for nerve transfer surgery. RVU per CPT code were an average of 13 RVUs for peroneal decompression and 37 RVUs for peroneal nerve transfer surgery. However, when average RVUs per hour were considered, peroneal decompression resulted with 11 RVU/hour compared to 8 RVU/hour with peroneal nerve transfer surgery.
Conclusions: Peripheral nerve surgeons represent a portion of the surgical community faced with a discrepancy between surgical complexity and financial compensation. Given both the time and technical skill required to perform nerve transfer surgery compared to nerve decompression, current reimbursements undervalue the complexity of nerve transfer surgery. Attempts at improving reimbursement rates to reflect the complexity of surgical expertise in complex nerve transfer require increased physician initiatives in influencing coding, billing and documentation. By striving to fairly increase the value of reimbursement for peripheral nerve transfer surgery, we will see improvements in hospital resource utilization as well as retaining talented surgeons within the field.


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