Suraj S. Parikh, MD
University of Pittsburgh Medical Center
Disclosure(s): No financial relationships to disclose
To study the volumes of cholecystostomy tube placement and cholecystectomy and their payments among Medicare beneficiaries from 2000 to 2018.
Materials and Methods:
Medicare claims from 2000 to 2018 were extracted from the Medicare Part B Physician/Supplier Procedure Summary Master File using the CPT codes for cholecystostomy tube placement (47490) and for both open and laparoscopic cholecystectomy (47562, 47563, 47600, and 47605). CPT codes where cholecystectomy was performed in conjunction with a larger surgery or with exploration of the common bile duct were excluded. Total volume and payment were analyzed in aggregate and by physician specialty. The physician work relative value unit (wRVU) for each procedure was obtained from the CMS Physician Fee Schedule tool.
The volume of cholecystostomy tube placement from 2000 to 2018 increased by 630% from 1,925 to 12,135 per year at a rate of 803.5 more procedures performed per year. Radiologists performed 89.7% of these procedures in 2000 increasing their share to 97.8% in 2018. The wRVU for cholecystostomy tube placement decreased from 8.13 in 2000 to 4.7 in 2010, and total payments per procedure went from $411.7 to $292.7. Payment per procedure has since trended down and was $266.5 in 2018.
Cholecystectomy volumes have decreased in the study period by 33% from 248,359 to 186,407 equating to 6,625 fewer surgeries per year since 2000. General surgeons performed the majority of these cases. Work RVUs for laparoscopic cholecystectomy slightly decreased from 11.09 to 10.47 and wRVU for the open procedure increased from 11.42 to 17.48. Compensation for the aggregate has increased per procedure from $430 to $489.5.
Cholecystostomy tube placement volume has increased by 630% from 2000 to 2018, while compensation was cut by over a third. Conversely, cholecystectomy volume has decreased by 33% during the same period, while compensation has increased.