Current Procedural Terminology Codes Research Articles

Utilization and reimbursement of diagnostic cerebral angiograms: A Medicare trends analysis from 2013 to 2020.

Increasing life expectancy has caused growing concern about maintaining viable neurointerventional practices due to altered Medicare payment structures. This study analyzes the financial trends of three common diagnostic tests for cerebrovascular disease: cerebral digital subtraction angiography (DSA), computed tomography angiography (CTA), and magnetic resonance angiography (MRA). Medicare Part B National Summary Data files from 2013 to 2020 were queried by Current Procedural Terminology (CPT) codes for DSA (36221-36228), CTA (70496, 70498), and MRA (70544-70547, 70549). Inflation-adjusted charges and reimbursement were calculated using the U.S. City Average Consumer Price Index for Medical Services. Regression analysis was performed on charges, reimbursement, and volume. A total of 1,519,245 diagnostic procedures were conducted between 2013 and 2020 (782,370 angiograms, 246,603 CTAs, and 490,272 MRAs). A total of $41.005 million was reimbursed by Medicare in 2020 for these diagnostic procedures. The annual percent change in volume for all procedures was -2.90%. From 2013 to 2020, inflation-adjusted: Medicare total physician reimbursement decreased for cerebral angiograms (-4.12%, p = 0.007), CTAs (-2.77%, p = 0.458), and MRAs (-9.06%, p < 0.001). Procedural volume billed to Medicare decreased for cerebral angiograms (-4.63%, p = 0.007) and MRAs (-2.94%, p = 0.0.81) and increased for CTAs (+3.15%, p = 0.004). The greatest increase in Medicare reimbursement (+66.75%) came from CPT code 36224, "place catheter carotid artery", and the greatest decrease in Medicare reimbursement (-8.66%) came from CPT code 36226, "place catheter vertebral artery." This study provides an analysis of Medicare reimbursement trends for routine cerebrovascular angiogram techniques. The findings highlight a decline in Medicare reimbursements for neurointerventionalists.

Effects of Non-Face-to-Face Chronic Care Management on Service Utilization and Outcomes Among US Medicare Beneficiaries with Diabetes.

Type 2 diabetes mellitus (T2DM) results in heavy economic and disease burdens in Louisiana. The Centers for Medicare and Medicaid Services has reimbursed non-face-to-face chronic care management (NFFCCM) for patients with two or more chronic conditions since 2015. To assess the impacts of NFFCCM on healthcare utilization and health outcomes. This retrospective cohort study included Medicare fee-for-service beneficiaries with T2DM and at least one additional chronic disease between 2014 and 2018. At least one record of NFFCCM Current Procedural Terminology codes. The health outcomes in the study included major adverse cardiovascular events (MACE), all-cause mortality, and heart failure. The monthly service utilization and continuity of care index for primary care were also included. The propensity score method was used to balance the baseline differences between the two groups. Weighted multivariate regression models were developed using propensity score weights to assess the impacts of NFFCCM on outcomes. During the 5years of study period, 8415 patients among the 118,643 Medicare beneficiaries received at least one NFFCCM. Patients receiving any NFFCCM had reduced healthcare utilization compared with patients not receiving NFFCCM, including 0.012 (95% CI - 0.014 to - 0.011; p < 0.001) fewer monthly hospital admissions, 0.017 (95% CI - 0.019 to - 0.016; p < 0.001) fewer monthly ED visits, and 0.399 (95% CI 0.375 to 0.423; p < 0.001) more monthly outpatient encounters. Patients receiving NFFCCM services had lower MACE event rates of 7.4% (95% CI 7.1 to 7.8%; p < 0.001), all-cause mortality rate of 7.8% (95% CI 7.4 to 8.1%; p < 0.001), and heart failure rate of 0.3% (95% CI 0.2 to 0.5%; p < 0.001), respectively. These findings suggest that reimbursement for NFFCCM was associated with the shifting high-cost utilization to lower-cost primary health care settings among patients with diabetes in Louisiana.

Leave it Alone: Ulnar Nerve Management in Distal Humerus Fracture Fixation – A Large Database Study

ABSTRACT Objectives: To determine the impact of intra-operative ulnar nerve manipulation during distal humerus open reduction internal fixation (ORIF) on post-operative ulnar neuritis. Methods: This study was a retrospective cohort analysis using the PearlDiver Mariner Database. Patients undergoing ORIF of distal humerus fractures were identified using Current Procedure Terminology (CPT) codes. Concurrent ulnar nerve transposition, neuroplasty, or neurolysis was defined using CPT-64718, occurring on the same day as the index procedure. Patients with pre-existing ulnar neuropathy within one year prior to the index procedure were excluded. The incidence of delayed ulnar neuropathy, occurring at least 2 weeks post-operatively, was compared at 3, 6, 9, and 12 months. Multivariable logistic regression models were employed to evaluate the association between ulnar nerve transposition, neuroplasty, or neurolysis and the development of delayed ulnar neuropathy, adjusting for the effects of age, sex, insurance type, and Elixhauser comorbidity index. Results: 16,881 patients who underwent distal humerus ORIF were identified, of which 2,016 (11.9%) received concurrent ulnar nerve transposition, neuroplasty, or neurolysis. The cohorts differed by age and insurance type (p&lt;0.001). Ulnar neuropathy between 2 weeks and 1 year occurred in 191/2,016 (9.5%) patients who received ulnar nerve transposition, neuroplasty, or neurolysis and 742/14,865 (5.0%) patients who did not (p &lt; 0.001). Ulnar nerve transposition, neuroplasty, or neurolysis was associated with increased odds of delayed ulnar neuropathy at all time points (p&lt;0.001). Conclusion: Ulnar nerve transposition, neuroplasty, or neurolysis at the time of distal humerus ORIF was associated with an increased incidence of delayed post-operative ulnar neuritis.

Perioperative outcomes in isolated versus multiligamentous anterior cruciate ligament reconstruction: a retrospective cohort analysis.

The outcomes of anterior cruciate ligament reconstruction in the setting of multiligamentous knee injury (M-ACLR) have not been well characterized compared to isolated ACLR (I-ACLR). This study aims to characterize and compare short-term outcomes between I-ACLR and M-ACLR. This is a retrospective cohort analysis of the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2017. Current Procedural Terminology codes were used to identify and compare elective I- and M-ACLR patients, excluding patients undergoing concomitant meniscal or chondral procedures. Patient demographics and outcomes after I- and M-ACLR were comparedusing bivariate analysis. Multiple logistic regression analyzed if multiligamentous ACLR was an independent risk factor for adverse outcomes. There was a total of 13,131 ACLR cases, of which 341 were multiligamentous cases. The modified fragility index-5 was higher in multiligamentous ACLR (p < 0.001). Multiligamentous ACLR had worse perioperative outcomes, with higher rate of all complications (3.8%, p = 0.013), operative time > 1.5h (p < 0.001), length of stay (LOS) ≥ 1day (p < 0.001), wound complication (2.1%, p = 0.001), and intra- or post-op transfusions (p < 0.001). In multiple logistic regression, multiligamentous ACLR was an independent risk factor for LOS ≥ 1 (odds ratio [OR] 5.8), and intra-/post-op transfusion (OR 215.1) and wound complications (OR 2.4). M-ACLR was not an independent risk factor for any complication, reoperation at 30days, readmission, urinary tract infection (UTI), or venous thromboembolism (VTE). M-ACLR generally had worse outcomes than I-ACLR, including longer LOS, need for perioperative transfusions, and wound complications.

Clinical Outcomes Before and After Prucalopride Treatment: An Observational Study in Patients With Chronic Idiopathic Constipation in the United States.

This real-world US-based claims study compared constipation-related symptoms and complications 6 months before and after prucalopride initiation in adults with chronic idiopathic constipation (CIC). This observational, retrospective cohort analysis used the IBM MarketScan Commercial Claims and Encounters Database and the Medicare Supplemental Database (January 2015-June 2020). Prucalopride-treated patients (≥18 years old) who had ≥1 constipation-related International Classification of Diseases, Tenth Revision, Clinical Modification ( ICD-10-CM ) diagnosis code during the baseline or study period were included. The proportions of patients with constipation-related symptoms (abdominal pain, abdominal distension [gaseous], incomplete defecation, and nausea) and constipation-related complications (anal fissure and fistula, intestinal obstruction, rectal prolapse, hemorrhoids, perianal venous thrombosis, perianal/perirectal abscess, and rectal bleeding) were examined. Constipation-related symptoms and complications were identified using ICD-10-CM , ICD-10 - Procedure Coding System , or Current Procedural Terminology codes. Data were stratified by age (overall, 18-64 years, and ≥65 years). This study included 690 patients: The mean (SD) patient age was 48.0 (14.7) years, and 87.5% were women. The proportions of patients overall with constipation-related symptoms decreased 6 months after prucalopride initiation (abdominal pain [50.4% vs 33.3%, P < 0.001]; abdominal distension [gaseous] [23.9% vs 13.3%, P < 0.001]; and nausea [22.6% vs 17.7%, P < 0.01]; no improvements observed for incomplete defecation). Similarly, the proportions of patients overall with constipation-related complications decreased 6 months after prucalopride initiation (intestinal obstruction [4.9% vs 2.0%, P < 0.001]; hemorrhoids [10.7% vs 7.0%, P < 0.05]; and rectal bleeding [4.1% vs 1.7%, P < 0.05]). This study suggests that prucalopride may be associated with improved constipation-related symptoms and complications 6 months after treatment initiation.

Compliance With Federal Price Transparency Rules and Cost Estimation at United States Hospitals With Neurosurgical Training Programs.

The Centers for Medicare & Medicaid Services implemented federal requirements on January 1, 2021, under the Public Health Service Act that require hospitals to provide a list of payer-negotiated prices or "standard charges" in a machine-readable file and in a patient-friendly online estimator for standard services. We sought to assess compliance by United States hospitals associated with neurosurgical training programs with these federal requirements for 11 common neurosurgical procedures. We performed a cross-sectional analysis in March 2023 of 116 United States hospitals associated with a neurosurgical training program to assess compliance with the new federal requirements to have a machine-readable, downloadable file with standard charges and a patient-friendly online estimator for two spinal procedures. A total of 110/114 (96.5%) hospitals were compliant with the requirement for a machine-readable file with payer-negotiated prices. A total of 47/110 hospitals (42.7%) were compliant with downloadable machine-readable files and reported at least one payer-negotiated price for 1 of the 11 common neurosurgical procedures. A total of 45/110 (40.9%) used bundled Diagnosis-Related Group codes, and 18/110 (16.4%) did not contain any price information for neurosurgical procedures. For neurosurgical procedures, the percent difference between the average negotiated private insurance and Medicare price per procedure ranged from 17.5% to 77.6%. Medicare and private insurance data for each procedure were available on average for 10.3 states (SD = 3.8) and 15.6 states (SD = 4.8), respectively. While hospital compliance with federal requirements for machine-readable files with payer-negotiated prices was high, availability of payer-negotiated prices for 4 major insurance types across 11 common neurosurgical procedures based on Current Procedural Terminology codes was sparce. Consequently, meaningful conclusions on procedure-related charges for elective procedures are difficult for patients to make because of the unintelligible format of data and a lack of reporting of charges per Current Procedural Terminology code in a comprehensive manner.

The impact of nuance DAX ambient listening AI documentation: a cohort study.

To assess the impact of the use of an ambient listening/digital scribing solution (Nuance Dragon Ambient eXperience (DAX)) on caregiver engagement, time spent on Electronic Health Record (EHR) including time after hours, productivity, attributed panel size for value-based care providers, documentation timeliness, and Current Procedural Terminology (CPT) submissions. We performed a peer-matched controlled cohort study from March to September 2022 to evaluate the impact of DAX in outpatient clinics in an integrated healthcare system. Primary outcome measurements included provider engagement survey results, reported patient safety events related to DAX use, patients' Likelihood to Recommend score, number of patients opting out of ambient listening, change in work relative values units, attributed value-based primary care panel size, documentation completion and CPT code submission deficiency rates, and note turnaround time. A total of 99 providers representing 12 specialties enrolled in the study; 76 matched control group providers were included for analysis. Median utilization of DAX was 47% among active participants. We found positive trends in provider engagement, while non-participants saw worsening engagement and no practical change in productivity. There was a statistically significant worsening of after-hours EHR. There was no quantifiable effect on patient safety. Nuance DAX use showed positive trends in provider engagement at no risk to patient safety, experience, or clinical documentation. There were no significant benefits to patient experience, documentation, or measures of provider productivity. Our results highlight the potential of ambient dictation as a tool for improving the provider experience. Head-to-head comparisons of EHR documentation efficiency training are needed.

Incidence, Complications, and Long-term Outcomes of Gender-affirming Phalloplasty: Analysis of a Large Statewide Population-based Dataset

ObjectiveTo evaluate the incidence of gender-affirming phalloplasty and complications in a large population-based dataset. MethodsRetrospective cohort study was done using the California Department of Health Care Access and Information datasets which include patient-level data from all licensed hospitals, emergency departments, and ambulatory surgery facilities in California. Adult patients 18 years or older undergoing gender-affirming phalloplasty in California from January 1, 2009 to December 31, 2019 were included. We examined phalloplasty-related complications using International Classification of Disease diagnosis and procedure codes and Current Procedural Terminology codes. Unique record linkage number identifiers were used to follow patients longitudinally. Statistical analysis included Kaplan-Meier survival analysis and Cox proportional hazards analysis. ResultsWe identified 766 patients who underwent gender-affirming phalloplasty in 23 facilities. Of 475 patients with record linkage numbers, 253 (55.3%) had subsequent re-presentations to the inpatient, emergency department, and ambulatory surgery settings related to phalloplasty complications. Survival analysis indicated that 50% of patients re-presented by 1 year post-phalloplasty. Asian/Pacific Islander patients had lower risk of complications, and California residents had higher risk of complications. ConclusionsThis population-based study confirms that gender-affirming phalloplasty has a high complication rate, and demonstrates for the first time an association with high rates of return to hospitals, emergency departments, and ambulatory centers. These findings provide additional higher-level evidence that may aid patient counseling, shared surgical decision making, and institutional and government policy.

Validation of administrative claims to identify ultrasound enhancing agent use

BackgroundUltrasound enhancing agents (UEAs) are an invaluable adjunct to stress and transthoracic echocardiography (STE) to improve left ventricular visualization. Despite multiple single center studies evaluating UEA use, investigation into the rates, sources of variation, and outcomes of UEA use on a national level in the United States (US) has been limited by lack of validation of UEA codes for claims analyses.MethodsWe conducted a retrospective cross-sectional study, 2019–2022, using linked multicenter electronic medical record (EMR) data from > 30 health systems linked to all-payor claims data representing > 90% of the US population. Individuals receiving STE in both EMR and claims data on the same day during the study window were included. UEA receipt as identified by presence of a Current Procedural Terminology (CPT) or National Drug Code (NDC) for UEA use within 1-day of the index STE event. We evaluated the performance of claims to identify UEA use, using EMR data as the gold standard, stratified by inpatient and outpatient status.ResultsAmongst 54,525 individuals receiving STE in both EMR and claims data, 12,853 (23.6%) had a UEA claim in EMR, 10,461 (19.2%) had a UEA claim in claims, and 9140 (16.8%) had a UEA claim in both within the 1-day window. The sensitivity, specificity, accuracy, positive, and negative predictive values for UEA claims were 71.1%, 96.8%, 90.8%, 87.4%. and 91.6% respectively. However, amongst inpatients, the sensitivity of UEA claims was substantially lower (6.8%) compared to outpatients (79.7%).ConclusionsWhile the overall accuracy of claims to identify UEA use was high, there was substantial under-capture of UEA use by claims amongst inpatients. These results call into question published rates of UEA use amongst inpatients in studies using administrative claims, and highlight ongoing need to improve inpatient coding for UEA use.

(177) Androgen Deprivation Therapy Does Not Increase Rates for Reintervention, Complication, or Infection in Penile Implant or Artificial Urinary Sphincter Surgery

Abstract Introduction Prostate cancer treatment carries significant quality of life implications, namely erectile dysfunction and stress urinary incontinence. Treatment options include genitourinary implants such as inflatable penile prosthesis (IPP) or artificial urinary sphincter (AUS). Given the association with androgens and penile and urethral health, there may be concern patients on androgen deprivation therapy (ADT) could have worse outcomes following IPP and AUS. Objective To evaluate whether patients on ADT undergoing IPP and AUS surgery are at increased risk for reintervention, complication, and infection. Methods We queried TriNetX, a collaborative research enterprise, for all adult male patients undergoing AUS or IPP. Cohorts were defined by those taking ADT 3 months before or anytime after surgery and those not taking ADT. ADT medications included: leuprolide, bicalutamide, flutamide, nilutamide, apalutamde, and darolide. We performed sub-analysis for leuprolide and bicalutamide, the two most prescribed ADT medications. Cohorts and outcomes were defined using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD-10) codes. We used the impact of age, prostate cancer, history of prostatectomy and history of radiation to generate propensity score matching (PSM). Our primary outcome was need for reintervention (revision, removal, or replacement surgery based on CPT codes). Secondary outcomes included infection rate and complication rate based on ICD-10 codes. Analytics were performed via TriNetX on demographic data which calculated Risk Ratios and were run July 2023. Results There were 12,143 patients who received an IPP and 5487 who received an AUS (Table 1), with. 401 and 635 patients on ADT, respectively. Patients on ADT had similar rates of reintervention (9.4% vs 12.9%, RR = 0.72, p = 0.11), complication (17.7% vs 22.8%, RR =0.78, p=0.08), and infection (4.1% vs 4.8%, RR =0.84, p=0.60) for IPP. For bicalutamide, patients had lower complication rates (11.3% vs 18.2%, RR = 0.62, p=0.04) and similar reintervention rates (5.2% vs 9.9%, RR = 0.52, p=0.07). There were less than 10 instances of infection and thus TriNetX rounded these numbers to 10 (denoted by *) as part of a patient safety mechanism. Rates were similar for patients on leuprolide (reintervention: 9.8% vs 8.9%, RR =1.1, p = 0.69, complication: 17.5% vs 17.8%, RR = 0.98, p=0.92, infection: 4.0% vs 4.9%, RR = 0.81, p=0.57). Patients receiving an AUS showed similar rates for reintervention (20.8% vs 24.0% RR =0.87, p=0.17), complications (26.1% vs 25.6%, RR=1.0, p=0.85), and infections (2.3% vs 3.7%, RR=0.61, p=0.13) regardless of ADT. This held true for subanalyses for bicalutamide (reintervention: 22.7% vs 22.3%, RR =1.0, p = 0.92, complication: 27.7% vs 24.6%, RR = 1.1, p=0.43, infection: 3.8%* vs 3.8%*, RR = 1, p=1)., and leuprolide (reintervention: 19.8% vs 23.3%, RR =0.85, p = 0.18, complication: 25.3% vs 28.7%, RR = 0.8, p=0.21, infection: 1.9%* vs 3.2%, RR = 0.59, p=0.17). Conclusions Patients with IPP or AUS seemingly do no worse on ADT and in some comparisons even seemed to fare better. Further evaluation into the duration of ADT may provide clinical context, but based on these results, ADT should not limit implant surgery. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Coloplast.

(373) Economic Benefits of Patient Care for Prostate Cancer Survivors with Stress Urinary Incontinence and/or Erectile Dysfunction: A Physician Reimbursement Analysis

Abstract Introduction Reconstructive urological procedures play a vital role in enhancing the satisfaction and quality of life of patients with prostate cancer (PCa) following radical prostatectomy (RP). Providing comprehensive postoperative care for common side effects of post-RP, including stress urinary incontinence (SUI) and erectile dysfunction (ED), may result in a greater number of patients with PCa receiving needed consultations and therapies. This analysis sought to explore the potential economic benefits of offering men’s health consultations and reconstructive care for PCa survivors. Objective This study quantified the relative value units (RVUs) generated from providing patient care to PCa survivors covered by Medicare Fee-for-Service who may experience SUI and/or ED due to RP. Methods This physician reimbursement analysis was based on typical patient care pathway scenarios for patients at risk of developing SUI or ED post-RP. Current Procedural Terminology (CPT) codes were utilized to identify and describe the care provided to patients in each scenario, leading to an artificial urinary sphincter (AUS) or male sling for SUI and/or an inflatable penile prosthesis (IPP) for ED. The 2023 CMS Physician and Clinical Laboratory Fee Schedule and Medicare reimbursement rates were used to obtain the most recent RVUs and reimbursement for each CPT. RVUs represent the value assigned to a service or procedure performed by a physician and are used to capture the relative cost values associated with patient care. For each scenario, we reported the total RVUs, which include work, non-facility or facility, and malpractice RVUs, and the total physician reimbursement. The 2023 Physician Conversion Factor was used to calculate the Medicare physician reimbursement. The Medicare physician reimbursement was used as a conservative estimate. Results The four clinical pathway scenarios were patients who did not experience recurrent SUI or ED (no recurrent SUI/ED), patients who only experienced SUI (only SUI), patients who only experienced ED (only ED), and patients who experienced both SUI and ED (SUI + ED). For the no SUI/ED scenario, the total RVUs from providing patient care were 5.26 RVUs, resulting in $205 in physician reimbursement. For the only SUI scenario, the total RVUs were 56.20 RVUs with an average of $1,996 in physician reimbursement for those receiving AUS and 55.54 RVUs with an average of $1,974 in physician reimbursement for those receiving male sling. For the only ED scenario, the total RVUs were 42.51 RVUs, resulting in $1,550 in physician reimbursement. For the SUI + ED scenario, the total RVUs were 98.71 RVUs with an average of $3,547 in physician reimbursement for those receiving AUS and 98.05 RVUs with an average of $3,524 in physician reimbursement for those receiving male sling. Conclusions This study justified the economic benefits of expanding patient care to men who underwent RP for PCa and provided urology practice insight into the potential physician reimbursement when PCa survivors were seen by reconstructive urologists. Disclosure Yes, this is sponsored by industry/sponsor: Boston Scientific. Clarification: Industry initiated, executed and funded study. Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.

(400) Geographic Disparity in Collagenase Clostridium Histolyticum Utilization: A National Population-Based Analysis

Abstract Introduction In 2013, the Food and Drug Administration approved the use of intralesional collagenase clostridium histolyticum for the treatment of Peyronie’s Disease. Objective To describe geographic utilization patterns of collagenase clostridium histolyticum. Methods The Medicare Provider Utilization and Payment Database was queried for all collagenase clostridium histolyticum injections (Current Procedural Terminology code 54200) performed between 2013 and 2020. The United States Census Bureau estimates for state population by male sex for 2020 were used to calculate the number of injections per male capita. Linear regression was performed with statistical significance set to 95% confidence intervals. Results Twenty-two states accounted for a total of 8,576 injections performed on 1,887 men. Five states (Georgia, California, Florida, North Carolina, and Delaware) represented over 50% of the injections per million male capita (figure). There were 28 states with zero injections recorded in the database. The number of injections per year increased from 263 in 2013 to 1,388 in 2020 (y=141.43x + 435.57, R2=0.71, p=0.008). All 8,576 injections were performed in urban vs. rural areas. Urologists and advanced practice providers (APPs) performed 8,309 (97%) and 267 (3%) of these procedures, respectively. The average reimbursement was $80.19 (SD $3.87) for urologists and $67.96 (SD $3.33) for APPs. Conclusions In this national population-based database, there was geographic disparity in the use of collagenase clostridium histolyticum for Peyronie’s Disease. Utilization increased fivefold from 2013 to 2020 and was limited to urban centers and less than half the states. APP’s performed a minority of injections. Disclosure No.

(241) Optimizing Care - Economic Impact of Reduced Teaching Visits After IPP Implantation

Abstract Introduction The increasing shortage of urologists has resulted in longer wait times for appointments and surgeries, causing delays in receiving care that may negatively impact quality-of-life, especially for erectile dysfunction (ED) treatment. Urologists specializing in inflatable penile prosthesis (IPP) implantation are familiar with such challenges and utilize various approaches to improve practice efficiency, including optimizing IPP teaching visits and post-operative care. Objective This study assessed whether reducing the number of IPP teaching visits within the immediate 90-day post-operative period may improve efficiency and enhance patient care amongst urology practices. Methods Using American Medical Association (AMA) resource-based relative value scale (RBRVS) data for IPP implantation [Current Procedural Terminology (CPT) 54405], a scenario analysis was constructed that assessed the effects on patient care and physician reimbursement of eliminating one 30-minute post-operative teaching visit (CPT 99213) from the average of 2.5 visits accounted for within the immediate 90-day postoperative period for CPT 54405 in RBRVS data. The efficiency impact on practices which perform 25, 50, or 100 IPP implants, annually, was modeled. The effects on patient access to care, by reapplying the time recaptured from the reduction in teaching visits, were evaluated under three scenarios: 1) the most frequent in-office CPT codes used by IPP implanters [from Definitive Healthcare 2021 commercial and Medicare claims], 2) evaluation and management of new ED patients who pursue/receive an IPP [CPT 99204 + 3x CPT 99214], and, as a control measure, 3) vasectomy procedures [CPT 55250]. Physician work time and reimbursement were conservatively estimated using 2023 Medicare Physician Fee Schedule. Changes to reimbursement if Advanced Practice Providers (APPs) in the urology practice provided post-operative IPP teaching were also modeled (data not shown). Results The reduction of one 30-minute post-operative IPP teaching visit for practices performing 25/50 / 100 IPP implants resulted in recapturing 750 /1,500/3,000 minutes annually, respectively. Applying this recaptured time to 1) commonly performed in-office visit types or procedures (Table 1), 2) evaluation and management of new ED patients, or 3) vasectomy translated to significant additional Medicare reimbursement, as high as $18,325 annually. At 25 IPP implants yearly, a urologist could care for an additional 13-25 patients through office visits, reaching $2,049-$2,270 in additional annual Medicare reimbursement. At 50 IPP implants yearly, clinical workups for 7 ED patients who go on to IPP implantation can result in an additional $4,125 of reimbursement, excluding any reimbursement from additional diagnostic procedures and/or downstream surgical cases. At 100 IPP implants yearly, recaptured schedule capacity can enable 37 patients for vasectomy care, resulting in a $12,563 reimbursement. Conclusions Regardless of IPP implant volume, practices optimizing care and achieving fewer post-operative IPP teaching visits gain additional schedule capacity that may serve more patients in the office and, potentially, the ability to treat more men with ED, including IPP implantation. These time savings and gains in practice efficiency enable implanters to manage patient demand and workload more effectively amidst the scarcity of urologists and growing wait times for care, while also helping ensure practice viability in the era of decreasing reimbursement. Disclosure Yes, this is sponsored by industry/sponsor: Boston Scientific - Data Acquisition, Statistical Support. Clarification: Industry funding only - investigator initiated and executed study. Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.

Risk of Subsequent Fusion After Isolated Decompression of Lumbar Facet Cysts.

Lumbar facet cysts represent a potential source of nerve root compression in elderly patients. Isolated decompression without fusion has proven to be a reasonable treatment option in properly indicated patients. However, the risk of lumbar fusion after isolated decompression and facet cyst excision has yet to be elucidated. The PearlDiver database was reviewed for patients undergoing isolated laminectomy for lumbar facet cyst from January 2015 to December 2018 using Current Procedural Terminology coding. Patients undergoing concomitant fusion or additional decompression, as well as those diagnosed with preexisting spondylolisthesis or without a minimum of 5-year follow-up, were excluded. Rates of subsequent lumbar fusion and potential risk factors for subsequent fusion were identified. Statistical analysis included descriptive statistics, chi square test, and multivariate logistic regression. Results were considered significant at P < 0.05. In total, 10,707 patients were ultimately included for analysis. At 5-year follow-up, 727 (6.79%) of patients underwent subsequent lumbar fusion after initial isolated decompression. Of these, 301 (2.81% of total patients, 41.4% of fusion patients) underwent fusion within the first year after decompression. Multivariate analysis identified chronic kidney disease, hypertension, and osteoarthritis as risk factors for requiring subsequent lumbar fusion at 5 years following the index decompression procedure ( P < 0.033; all). Patients undergoing isolated decompression for lumbar facet cysts undergo subsequent lumbar fusion at a 5-year rate of 6.79%. Risk factors for subsequent decompression include chronic kidney disease, hypertension, and osteoarthritis. This study will assist spine surgeons in appropriately counseling patients on expected postoperative course and potential risks of isolated decompression.

Estimating rare disease prevalence and costs in the USA: a cohort study approach using the Healthcare Cost Institute claims data

ObjectiveThe study capitalised on national insurance claims data to gather information on patient characteristics and associated costs to better understand the diagnosis and treatment of rare diseases (RDs).Materials and methodsData...

Characteristics of Femoral Shaft Fractures That Predict Ipsilateral Femoral Neck Fractures.

This study aims to characterize radiographic features and fracture characteristics in femoral shaft fractures with associated femoral neck fractures, with the goal of establishing predictive indicators for the presence of ipsilateral femoral neck fractures (IFNFs). A retrospective cohort was collected from the electronic medical record of three level I trauma centers over a 5-year period (2017 to 2022) by current procedural terminology (CPT) codes. Current CPT codes for combined femoral shaft and IFNFs were identified to generate our study group. CPT codes for isolated femur fractures were identified to generate a control group. One hundred forty patients comprised our IFNF cohort, and 280 comprised the control cohort. On univariate, there were significant differences in mechanism of injury (P < 0.001), Orthopedic Trauma Association (OTA)/Arbeitsgemeinshaft fur Osteosynthesefragen (AO) classification (P = 0.002), and fracture location (P < 0.001) between cohorts. On multivariate, motor vehicle crashes were more commonly associated with IFNFs compared with other mechanism of injuries. OTA/AO 32A fractures were more commonly associated with IFNFs when compared with OTA/AO 32B fractures (adjusted odds ratio = 0.36, P < 0.001). Fractures through the isthmus were significantly more commonly associated with IFNFs than fractures more proximal (adjusted odds ratio = 2.52, P = 0.011). Detecting IFNFs in femoral shaft fractures is challenging. Motor vehicle crashes and motorcycle collisions, OTA/AO type 32A fractures, and isthmus fractures are predictive of IFNFs.

Corticosteroid Injections Administered Within 4 Weeks Prior to Hip Arthroscopy Are Associated With Higher Rates of Postoperative Infection

PurposeThe purpose of this study was to evaluate the association between the timing of intra-articular hip corticosteroid injections and the risk of postoperative infection in patients undergoing hip arthroscopy. MethodThe 2010-2021 PearlDiver M157 administrative claims database was queried for patients who underwent hip arthroscopy. Patients who received intra-articular corticosteroid injections within 12 weeks prior to arthroscopy were matched to those who did not 1:1 based on age, sex, and Elixhauser-Comorbidity Index, and the presence of diabetes mellitus, hypertension, obesity, and tobacco use. Those with injection prior to arthroscopy were subdivided based on having had the injection within 12 weeks prior to surgery. To verify that the corticosteroid injection and surgery were conducted in the hip joint, Current Procedural Terminology (CPT) codes were utilized. Using CPT coding and the International Classification of Diseases (ICD) 9th or 10th Revision, postoperative surgical site infection following corticosteroid injection was evaluated. The impact of the timing of preoperative corticosteroid injections on the incidence of postoperative infection was evaluated using multivariable logistic regression analysis. ResultsA total of 12,390 hip arthroscopy cases were identified, including 3,579 patients who received a corticosteroid injection 0-4 weeks prior to the surgery, 4,759 within 4-8 weeks prior to the surgery, and 4,052 within 8-12 weeks prior to the surgery. Compared to controls, patients who received a corticosteroid injection within 0-4 weeks preoperatively had a significantly higher rate of surgical site infection (OR 2.43; P=0.0001). No significant differences were observed in infection rates at the later time intervals (4-8 weeks or 8-12 weeks). Furthermore, in comparison to controls, patients who received a corticosteroid injection had a significantly higher rate of wound dehiscence (OR 1.84, P=0.0007). ConclusionIntra-articular corticosteroid injections within 4 weeks prior to hip arthroscopy were significantly associated with increased surgical site infection rates following hip arthroscopy surgery.

Contemporary Trends of Holmium Laser Enucleation of the Prostate Utilization in the United States: A Comprehensive Analysis Using the National Surgical Quality Improvement Program Database (2011-2020).

Introduction: The most recent American Urological Association (AUA) Guidelines advocated laser enucleation of the prostate (LEP) as a size-independent surgical option for benign prostatic hyperplasia (BPH). Despite its endorsement by AUA and the growing body of evidence supporting its safety and efficacy, the utilization of LEP remains limited in the United States. This study aimed to evaluate the utilization trends and perioperative outcomes of LEP compared with other surgical procedures used for BPH management. Methods: A retrospective cohort analysis was performed using American College of Surgeons National Surgical Quality Improvement Program data from 2011 to 2020. Patients undergoing prostatectomy for BPH were identified using specific current procedural terminology (CPT) codes. Baseline demographic data, preoperative risk factors, and postoperative outcomes were collected. Multivariable logistic regression was employed to assess predictors of holmium laser enucleation of the prostate (HoLEP) utilization and postoperative complications. Results: Out of 8,415,549 patients, 95,144 underwent prostatectomy for BPH. Procedures included HoLEP 5305 cases, transurethral resection of the prostate (TURP) 57,803 cases, repeated TURP (re-TURP) 5549 cases, photoselective vaporization of the prostate (PVP) 23,739 cases, and simple prostatectomy 2748 cases. HoLEP utilization showed a gradual increase, from 4.8% in 2015 to 7.6% in 2020. Multivariable regression revealed that HoLEP selection significantly increased from 2016 to 2020 (odds ratio [OR]: 1.251, p < 0.001), and there was less likelihood of HoLEP selection for African American patients (OR: 0.752, p < 0.001). HoLEP had significantly lower complication rates, including urinary tract infections, blood transfusions, 30-day readmission, and reoperation. Conclusion: Despite underutilization, the adoption of HoLEP has slightly increased since 2015, rising from 4.8% in 2015 to 7.6% in 2020. The underutilization could be attributed to a lack of availability and the steep learning curve.

The association between patient preoperative disposition and outcomes after diagnostic lung biopsy.

Surgical diagnostic lung biopsy (DLB) is performed to guide the management of pulmonary disease with unclear etiology. However, the utilization of surgical DLB in critically ill patients remains unclear. The purpose of this study was to determine if patient preoperative disposition impacts complication rates after DLB. This was retrospective cohort study using electronic health record (EHR) data at one academic institution [2013-2021]. Patients who underwent DLB were identified using current procedural terminology (CPT) codes and cohorted based on preoperative disposition. The primary outcome was 30-day mortality; secondary outcomes were overall morbidity, individual complications, and changes to medical therapy. Complication rates were compared using chi-squared tests, Fisher's exact tests, or analysis of variance (ANOVA). Multivariable logistic regression was performed to generate risk-adjusted odds ratios (ORs) for each complication. Of 285 patients, 238 (83.5%) presented from home, 26 (9.1%) from inpatient floor units, and 21 (7.4%) from intensive care units (ICUs). Patients requiring ICU had the highest 30-day rates of mortality, overall morbidity, and all individual complications (all P<0.05). After risk adjustment, non-ICU inpatients had higher odds of postoperative ventilator use, prolonged ventilation, and ICU need than outpatients (all P<0.05). Preoperative ICU disposition was associated with increased OR of 30-day mortality [OR, 70.92; 95% confidence interval (CI): 5.55-906.32] and overall morbidity (OR, 7.27; 95% CI: 1.93-27.42) compared to patients with other preoperative dispositions. There were no differences in changes to medical therapy between the cohorts. Patients requiring ICU before DLB had significantly higher risk-adjusted rates of mortality and postoperative complications than outpatients and other inpatients. A clear benefit from tissue diagnosis should be defined prior to performing DLB on critically ill patients.

Capsular Repair, Labral Repair, and Femoroplasty are Increasingly Performed for the Arthroscopic Treatment of Femoroacetabular Impingement Syndrome

PurposeThe purpose of our study was to provide an updated assessment of hip arthroscopy utilization using an institutional database that is specific to the treatment of femoroacetabular impingement syndrome (FAIS). MethodsAll patients undergoing hip arthroscopy for the treatment of FAIS were retrospectively identified between the years 2014 and 2022 via Current Procedural Terminology (CPT) coding in a multi-institutional, single health-system database. A longitudinal analysis was performed to identify trends in the utilization of arthroscopic techniques including capsular and labral treatment, osteoplasty, and traction set-up. ResultsDuring the study, a total of 789 arthroscopic hip procedures in 733 patients were analyzed (56 staged bilateral). Between 2016 and 2022, the number of hip arthroscopies performed each year increased by 1490% (R2 =0.87, p=0.001). Capsular repair (R2=0.92, p<0.001), labral repair (R2=0.75, p=0.002), and femoroplasty (R2=0.70, p=0.004) were performed in an increasing proportion of cases over our study period while labral debridement (R2=-0.84, p<0.001) became less utilized. Postless traction systems were employed in 84% (663/789) of hip arthroscopies overall, were used in at least 70% of hip arthroscopies each year, and did not undergo any significant changes in utilization (R2=0.02, p=0.73). ConclusionCapsular repair, labral repair, and femoroplasty were increasingly performed for the arthroscopic treatment of FAIS while the use of labral debridement decreased significantly over our study period. Postless traction systems were utilized in the majority of cases each year. Clinical RelevanceAs comparative literature continues to define the safety and efficacy of hip arthroscopy, understanding how novel techniques or procedures are incorporated in clinical practice is important.