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John T. Smith, MD Jessica V. Morgan John A. Heflin, MD

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Presentation on theme: "John T. Smith, MD Jessica V. Morgan John A. Heflin, MD"— Presentation transcript:

1 John T. Smith, MD Jessica V. Morgan John A. Heflin, MD
Comparison of Billing Practices and Reimbursement Associated with Rib-Based Growing Constructs and Magnetically Controlled Growing Rod Procedures. John T. Smith, MD Jessica V. Morgan John A. Heflin, MD

2 Disclosures Smith: Consultant: DepuySynthes, Globus, Biomet, Spineguard. Royalties: VEPTR 2 device; Board of Directors: Children’s Spine Foundation Heflin: Consultant: Globus, Medtronic Morgan: Nothing to disclose

3 Background There are no established CPT codes to guide billing and reimbursement for growth-friendly spine procedures Billing and reimbursement is highly variable Most surgeons use unlisted procedure codes There is no consensus on how to bill for in-office lengthening of MCGR’s

4 Purpose Compare reimbursement for outpatient MCGR lengthening procedures to operative lengthening of growing rods or rib-based constructs

5 Methods Study period: 12/2014-06/2016
52 Rib-based constructs (RBC’s)with operative lengthening procedures 22 patients with in-office lengthening of magnetically controlled growing rods (MCGR’s) All procedures billed as unlisted (99) procedure codes Reimbursement compared to a level 5 office visit (99215)

6 Results: MCGR (Office) RBC (Operative) Level 5 Office visit
Average billed charges $2151 $6885 $322 Average reimbursement Commercial $977 $4188 $252 Government $648 $2590 $124

7 Discussion Outpatient MCGR lengthening billed as a procedure code is reimbursed at a discounted rate ranging from 30-45% of billed charges Operative RBC lengthening procedures are reimbursed at a discounted rate of 42-69% Level 5 visits: Discounted 39-75%

8 Conclusion When billed as an outpatient procedure, reimbursement for lengthening of MCGR’s is significantly higher than a level 5 clinic visit With the lack of clearly defined codes for growth friendly surgical procedures, the correct way to charge for lengthening remains unclear

9 Limitations Single practice site, Surgeon experience
Regional variation in billing and reimbursement practices nationally in the US

10 Thank You

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