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Conversion Total Knee Arthroplasty Needs Its Own Diagnosis-Related Group Code.

Michael Yayac1, Jonah Stein1, Gregory K Deirmengian1

  • 1The Rothman Institute at Thomas Jefferson University, Philadelphia, PA.

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|June 25, 2019
PubMed
Summary

Conversion total knee arthroplasty (TKA) incurs higher costs than primary TKA, especially after open knee surgery. This study highlights the need for distinct billing codes for conversion TKA due to its increased complexity and expense.

Keywords:
conversioncostshealth policyoutcomestotal knee arthroplasty

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Area of Science:

  • Orthopedic Surgery
  • Health Economics
  • Medical Cost Analysis

Background:

  • Conversion total knee arthroplasty (TKA) procedures are resource-intensive but lack distinct procedural codes.
  • Primary TKA and conversion TKA are currently grouped similarly for billing and resource allocation.
  • Understanding cost disparities is crucial for healthcare resource management.

Purpose of the Study:

  • To quantify and compare facility costs between primary TKA and conversion TKA.
  • To identify factors contributing to cost differences in TKA procedures.
  • To provide evidence for potential changes in medical billing and coding.

Main Methods:

  • Retrospective review of 2447 TKA procedures (2015-2017) across two hospitals.
  • Itemized facility cost comparison between primary and conversion TKA cohorts.
  • Multivariate regression analysis to identify predictors of cost, implant usage, length of stay, and discharge disposition.

Main Results:

  • Conversion TKA showed significantly higher implant costs ($3931.47 vs $2864.67) and total facility costs (+$94.30).
  • Prior open reduction internal fixation ($847 increase) and ligament reconstruction ($402 increase) independently predicted higher costs.
  • Patients with prior procedures were more likely to require stemmed implants, increasing TKA implant costs by $538.

Conclusions:

  • Conversion TKA is demonstrably more expensive than primary TKA, particularly for patients with prior open knee surgery.
  • The increased cost and complexity warrant a separate diagnosis-related group for conversion TKA.
  • Implementing distinct coding could improve resource allocation and financial recognition for conversion TKA procedures.