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Baseer Ahmad, Gaurav Shah, Kevin Blinder; Trends in choice of surgical technique and reimbursement for retinal detachment repair. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5767. doi: https://doi.org/.
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The aim is to evaluate current trends in surgeon choice of retinal detachment repair technique, particularly with a focus on changes in scleral buckling relative to vitrectomy over the past decade. Additionally, we wish to assess any significant changes in reimbursement for the techniques stated above.
The Medicare fee for service database (BESS, the Part B Extract Summary System) was analyzed over a 10 year period from 2000 to 2010 using CPT codes 67107 (scleral buckle), 67108 (vitrectomy), 67113 (complex repair), 67110 (pneumatic retinopexy), 67105 (laser demarcation), and 67101 (cryoretinopexy). Data collected included overall number of procedures performed, number of procedures with skilled assistants, average allowable billing per procedure, and average allowable skilled assistant supplement per procedure.
During the period from 2000-2010, annual numbers of surgical procedures changed as follows: scleral buckling decreased from 6502 to 1938, vitrectomy increased from 14984 to 30259, pneumatic retinopexy remained stable from 3033 to 3164, laser retinopexy increased from 4379 to 5834, and cryoretinopexy decreased from 1306 to 924. Average reimbursement from 2000-2010 changed as follows: $948 to $1049 for scleral buckling, $1260 to $1316 for vitrectomy, $797 to $745 for pneumatic retinopexy, $581 to $625 for laser demarcation, and $481 to $579 for cryoretinopexy.
There has been a clear trend away from scleral buckling toward primary vitrectomy for repair of retinal detachments over the past decade. Utilization of other techniques has remained stable. Although the higher reimbursement of vitrectomy may have played a role, reimbursement for both scleral buckling and vitrectomy have trended upward at approximately the same pace. It is likely that other factors such as advancements in small gauge vitrectomy surgery, industry involvement in vitrectomy instrumentation, and reduced emphasis on scleral buckling during fellowship training over the past decade have also contributed to these trends.
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