New Incentives for Arthroscopic Hip Surgery

Even before CMS increased reimbursement, the market for arthroscopic hip surgery was growing.  Arthroscopic surgery has been the mainstay for knee and shoulder repair procedures for years.  But, in the past, hip applications have been limited due to the complexity of joints.  Now, a combination of new technology and increased reimbursement for both physicians and hospitals will make it easier for more leading-edge providers to offer the procedure.

For 2011, CMS issued three new arthroscopic CPT codes: 29914 (arthroscopic, hip surgery w/ femoroplasty), 29915 (arthroscopic, hip surgery w/ acetabuloplasty), and 29916 (arthroscopic, hip surgery w/ labral repair).  These new codes are now assigned to APC 0042 (Level II Arthroscopy), which has a payment level of $3,290.  Prior to 2011, arthroscopic hip surgery was coded under CPT 29999 (unlisted procedure, arthroscopy).  This catch-all code falls under APC 0041 (Level I Arthroscopy) and is reimbursed at $2,069.

In the last five years, the market has almost tripled and will continue to grow with a more active population.  Around 2006, there were around 15,000 arthroscopic hip surgeries performed each year in the U.S.  In 2008, over 30,000 were performed and the market is projected to reach 70,000 by 2012.

Improved outcomes are a driving force behind the rapid growth in arthroscopic hip surgery.  One recent study that compared both open and arthroscopic procedures showed that the average improvement in the modified Harris hip score after surgery was 26.4% for arthroscopy and 20.5% for open surgery.  In addition, there were also almost 80% fewer complications for the arthroscopy group.

Lowered costs and quicker recovery are two other attractive features for arthroscopic hip surgery.  Costs for open hip procedures range from $7,000 to $16,000, but arthroscopic procedures are just $2,000 to $3,500.  In addition, patients treated with an open surgical procedure are subject to up to four days in the hospital if there are no complications; arthroscopic patients, less than 24 hours.

Lowered costs, quicker recovery, and now increased reimbursement?  This looks exciting!

James Laskaris, EE, BME
James Laskaris, EE, BME, Clinical Analyst — Mr. James Laskaris is a senior emerging technology analyst at MD Buyline and has been with the company since 1994. With over 30 years of experience in the healthcare field, Mr. Laskaris is the primary analyst of high-end OR technology. He also covers issues related to the legislative and reimbursement effect on healthcare and authors a bimonthly “Issues that Matter” publication. Mr. Laskaris received his biomedical engineering degree from Southern Illinois University. His work has been published in hfm Magazine, Radiology Manager and Healthcare Purchasing News.