Evaluating the Accuracy of Relative Value Unit and Operative Time Changes in Breast Reconstruction

As part of the 2021 changes to breast reconstruction CPT codes, the Relative Value Scale Update Committee (RUC) recommended adjustments to work RVUs (wRVUs) based on newly surveyed intraoperative times. The authors' objective was to gauge the accuracy of operative time and wRVU adjustments using national data as a benchmark.

The authors queried the National Surgical Quality Improvement Program (NSQIP) database for operative times from 2005 to 2021 for reevaluated CPT codes. For each code, the authors compared NSQIP median operative times with Centers for Medicare and Medicaid Services (CMS) historical operative times and the RUC's 2021 recommendations. CPT code 19364 (breast reconstruction with free flap) was not reevaluated but was included for comparison. Linear regression modeled the change in NSQIP median intraoperative time by year.

For 9 reevaluated CPT codes, NSQIP operative times were derived from 59,941 cases from 2005 to 2021. RUC-recommended operative times were shorter than NSQIP benchmarks for 3 CPT codes (19316, 19325, and 19340) by 2 to 7 minutes and longer for 6 codes (19318, 19328, 19330, 19342, 19357, and 19380) by 1 to 44 minutes. Compared with operative times before reevaluation, 2021 RUC times better approximated median NSQIP times by 4.5% overall. Operative times decreased significantly over time for most CPT codes.

The 2021 RUC recommendations for intraoperative times were collectively more accurate compared with prior CMS times when measured against NSQIP benchmarks. Despite these improvements, the CMS chose not to adopt many of the RUC's recommendations and lowered wRVU values more than recommended. These findings question the necessity and favorability of future efforts to reevaluate CPT code 19364.