Analyzing Variation in Fronto-Orbital Advancement Coding: Insights From 2569 Cases

Area of Science:

• Craniofacial Surgery
• Health Services Research
• Surgical Billing

Background:

• Fronto-orbital advancement (FOA) is a surgical procedure often involving temporalis muscle dissection.
• National billing practices for the use of temporalis muscle flaps in FOA are not well characterized.
• Variations in billing can impact reimbursement and transparency in pediatric craniofacial surgery.

Purpose of the Study:

• To analyze national billing patterns for temporalis muscle flaps in pediatric fronto-orbital advancement (FOA).
• To identify factors associated with the use of separate billing codes for temporalis muscle flaps during FOA.
• To assess the implications of billing variations on surgical practice and reimbursement.

Main Methods:

• Retrospective cohort analysis of deidentified data from the Pediatric National Surgical Quality Improvement Program (PNSQIP), 2016-2021.
• Identification of FOA cases using CPT code 21175.
• Categorization of cases based on the presence or absence of temporalis muscle flap CPT codes (15732/15733).
• Comparison of perioperative variables including operative time, anesthesia time, length of stay, and primary surgical specialty.

Main Results:

• Of 2569 FOA cases, 601 (23.4%) included additional temporalis muscle flap codes.
• Cases with flap codes had significantly longer operative times (254 vs. 240.6 min) and anesthesia times (369.2 vs. 353.3 min).
• Length of stay did not differ significantly between groups (P = 0.077).
• Plastic surgery was the primary specialty in most FOAs (57.2%) and was more likely to use flap codes compared to otolaryngology (24.6% vs. 9.6%).

Conclusions:

• A significant proportion of fronto-orbital advancement procedures are billed with separate codes for temporalis muscle flaps, despite dissection being inherent.
• This billing variation likely reflects differing interpretations of coding guidelines rather than surgical technique.
• Standardized coding guidelines are needed to ensure transparency and equitable reimbursement in craniofacial surgery.