修改器22 用于收费服务医疗保险的使用
Christopher P Childers1, Naveen V Manisundaram2, Chung-Yuan Hu3
1Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston.
修改器22为复杂的手术病例提供了很少的财务利益,拒绝率增加和混合支付结果. 根据目前的报销制度,外科医生对使用这种修饰剂的动力有限.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 外科手术补偿金 医疗补偿金
- 卫生经济学 卫生经济学
背景情况:
- 修改器22旨在考虑超出标准流程术语 (CPT) 代码的外科复杂性.
- 关于修饰剂22在外科实践中的利用和有效性的实证数据有限.
研究的目的:
- 为了评估修饰剂22在常见的外科手术程序中的应用.
- 为了确定修饰剂22使用与外科医生补偿之间的关联.
主要方法:
- 对2021年医疗保险B部分服务费索赔进行了横截面分析.
- 分析了10种常见的外科手术类型中的625,316项手术的数据.
- 关键指标包括修改器22的使用率,索赔拒绝率和支付变化.
主要成果:
- 修饰剂22的使用因手术而异,从2.3% (全膝关节整形术) 到8.5% (腹腔镜全腹切除术).
- 使用修改器22的索赔显示了更高的提交费用,但接受付款的增加仅为边际,同时拒绝率明显更高 (7.4%与4.0%相比).
- 总体而言,平均支付不一致,大多数手术没有明确的财务优势,移植的增加很小.
结论:
- 修饰剂22为广泛的外科手术程序提供了最小的或没有经济利益.
- 目前的报销结构为外科医生提供了很少的激励,以利用修改器22复杂的病例.
- 需要改进机制,以确保进行更困难手术的外科医生获得适当的报酬.
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