Pediatric Neurosurgery Procedural Coding: Current Lay of the Land

Physician compensation models increasingly rely on productivity metrics, with current procedural terminology (CPT) codes and relative value unit (RVU) assignments standardizing procedure complexity and informing reimbursement. Pediatric neurosurgery receives lower RVU assignments than adult counterparts, with many procedures lacking assigned codes despite yearly evaluations. Understanding current coding knowledge, patterns, and interest in change among pediatric neurosurgeons is essential for accurate CPT and RVU alignment with procedure complexity.

The Pediatric Coding and Reimbursement Committee developed a 24-question survey using Modified Delphi methodology to assess coding habits, knowledge, training, resources, and perceptions within pediatric neurosurgery. The American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Pediatric Section distributed the survey to members in Spring 2024, collecting 119 responses.

Response rate for the survey was 21.6%. Overall, 94.2% of the respondents were full-time attendings and the remainder were fellows (3.3%) and residents (2.5%). Although 55.6% code independently or with billing departments, others rely solely on billing assistance. Self-reported coding knowledge was poor, with only 15.7% feeling confident coding without billing support. Notably, 59.3% have never performed formal coding training postresidency, and 30.6% do not know how to find formal training. In addition, 41.6% were unfamiliar with American Association of Neurological Surgeons coding resources. However, 68.6% considered coding "very" important for training incorporation, and 90.2% believed a Pediatric Neurosurgery Coding Manual would be beneficial. Clinical scenarios with unclear coding guidance showed significant practice variability.

The pediatric coding landscape features predominantly large academic practices with RVU-based compensation, yet individual surgeons report disparities between coding importance and abilities. Despite expressing poor coding knowledge and limited awareness of formal training resources, pediatric neurosurgeons demonstrate high interest in coding education while simultaneously expressing poor coding knowledge and lack of awareness of formal training or online resources. These findings highlight significant opportunities for coding education and standardization within existing CPT architecture, enabling better protection of the field's financial viability through improved reimbursement understanding.