Comparing Relative Value Units for Intramedullary Limb Lengthening Procedures to Common Pediatric Orthopaedic...

Area of Science:

• Orthopaedic surgery
• Health economics
• Surgical outcomes

Background:

• Reimbursement for surgical procedures is determined by relative value units (RVUs) based on work, resources, and expertise.
• The limb lengthening field has evolved, necessitating an evaluation of RVU comparability across orthopaedic subspecialties.

Purpose of the Study:

• To compare the work relative value unit (wRVU) totals for three common pediatric orthopaedic surgeries: arthroscopic ACL reconstruction, spinal fusion for adolescent idiopathic scoliosis, and antegrade femoral intramedullary limb lengthening.
• To assess if RVU values are comparable across different orthopaedic subspecialties.

Main Methods:

• A multicenter, retrospective chart review of 50 cases per procedure (ACL reconstruction, spinal fusion, femoral lengthening).
• Comparison of mean procedure duration, CPT codes billed, postoperative visits within the 90-day global period, and wRVU.
• Study design: Level III-retrospective comparison.

Main Results:

• The antegrade femur lengthening group had the lowest wRVU per hour (P < 0.0001).
• Limb lengthening patients had significantly more postoperative visits in the 90-day global period (P < 0.0001).
• Intramedullary limb lengthening procedures had the fewest CPT codes billed.

Conclusions:

• RVUs per time are lowest for limb lengthening and highest for scoliosis surgery.
• Limb lengthening patients require more postoperative visits and time, which do not add RVU value and occupy valuable clinic slots.
• A review of RVU values for limb lengthening codes is recommended.