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Walter R Smith¹, Allyson N Pfeil¹, Matthew A Coker²

¹Fondren Orthopedic Research Institute, Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX, USA.

JSES reviews, reports, and techniques

|May 5, 2025

概括

肩膀手术中的22-修饰剂的补偿不一致,医疗保险支付的比商业支付者更多. 外科医生可以通过记录手术的复杂性和长度来提高成功率.

科学领域:

整形外科手术整形外科手术
医疗保健补偿医疗保健补偿
医疗账单计费医疗账单计费

背景情况:

22修饰符 (当前程序术语) 用于复杂的外科病例.
怀疑肩部手术的22变量补偿率存在差异.
支付者,特别是商业支付者,可能会低于偿还大量手术费用.

研究的目的:

为了调查在肩膀手术中的22-修饰剂的补偿率.
确定影响成功22-修饰器退款的因素.
突出支付人退款方面的潜在差异.

主要方法:

分析了566例使用22修饰剂的病例,用于全肩关节整形术,TSA修复和旋转手套修复 (2018-2022).
收集财务,人口和运营报告数据.
根据付款人类型检查了复杂性证明和退款结果.

主要成果:

总体而言,22个修改剂的报销率为26.5%.
根据程序的报销率有所不同:TSA (40.7%),修订TSA (35.3%),旋转手臂修复 (13.0%).
医疗保险退还了75.3%的成功索赔,而商业支付者退还了26.7%.

结论:

对22修改器的退款标准不清楚,这阻碍了成功的索赔.
专注于记录的程序长度,修订和逆肩关节整形术可能会改善医疗保险退款.
提交详细的覆盖表,解释复杂性,可以增加退款的成功.

关键词:

这是一个22-修改器.补偿补偿补偿补偿复杂性修饰器复杂性修饰器医疗保险的退款率是多少整形外科的赔偿费用肩部整体关节整形术肩部整体关节整形

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