Variation in Coding Practices for Vestibular Schwannoma Surgery

Abstract

Introduction Nationwide databases are frequently used resources for assessing practice patterns and clinical outcomes. However, analyses based on billing codes may be limited by the inconsistent application of current procedural terminology (CPT) codes to specific operations. We investigated the variability among commonly used CPT codes for vestibular schwannomas resection and sought to identify factors that underlie this variation.

Methods The surgical procedure for 274 cases of vestibular schwannoma resections from two institutions was reviewed and classified as retrosigmoid, translabyrinthine, or middle fossa approaches. We then assessed the CPT codes assigned to each case and analyzed their association with surgical approach, surgeons involved, the coding specialty, and year of surgery. We further compared the incidence of CPT codes assigned for vestibular schwannoma surgeries in the American College Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2010 to 2014.

Results The majority (65%) of vestibular schwannoma resections within the institutional cohort were billed with skull base approach and/or excision codes, whereas 76% of cases in NSQIP were associated with a single craniotomy for tumor code. The use of skull base codes over the past decade increased within our institutional cohort but remained relatively stable within NSQIP. CPT codes did not consistently reflect the operative approaches for vestibular schwannomas.

Conclusion We observed significant variability in coding patterns for vestibular schwannoma surgeries within institutions, surgical practices, and national databases. These results call for discretion in interpretation of data from aggregated billing code-based nationwide databases and suggests a role for institutional standardization of CPT assignments for the same approaches.

Keywords

vestibular schwannoma - acoustic neuroma - skull base surgery - CPT coding - practice patterns

• References

• 1 Karhade AV, Larsen AMG, Cote DJ, Dubois HM, Smith TR. National Databases for Neurosurgical Outcomes Research: options, strengths, and limitations. Neurosurgery 2017 doi: 10.1093/neuros/nyx408
• 2 Murphy M, Gilder H, McCutcheon BA. , et al. Increased operative time for benign cranial nerve tumor resection correlates with increased morbidity postoperatively. J Neurol Surg B Skull Base 2016; 77 (04) 350-357
• 3 Murphy ME, McCutcheon BA, Kerezoudis P. , et al. Morbid obesity increases risk of morbidity and reoperation in resection of benign cranial nerve neoplasms. Clin Neurol Neurosurg 2016; 148: 105-109
• 4 Mahboubi H, Haidar YM, Moshtaghi O. , et al. Postoperative complications and readmission rates following surgery for cerebellopontine angle schwannomas. Otol Neurotol 2016; 37 (09) 1423-1427
• 5 O'Connell BP, Rizk HG, Stevens SM, Nguyen SA, Meyer TA. The relation between obesity and hospital length of stay after elective lateral skull base surgery: an analysis of the American College of Surgeons National Surgical Quality Improvement Program. ORL J Otorhinolaryngol Relat Spec 2015; 77 (05) 294-301
• 6 Schwam ZG, Michaelides E, Kuo P, Hajek MA, Judson BL, Schutt C. Thirty-day morbidity and mortality following otologic/neurotologic surgery: analysis of the national surgical quality improvement program. Laryngoscope 2018; 128 (06) 1431-1437
• 7 Vedantam A, Mayer RR, Staggers KA, Harris DA, Pan IW, Lam SK. Thirty-day outcomes for posterior fossa decompression in children with Chiari type 1 malformation from the US NSQIP-Pediatric database. Childs Nerv Syst 2016; 32 (11) 2165-2171
• 8 Cole T, Veeravagu A, Zhang M. , et al. Retrosigmoid versus translabyrinthine approach for acoustic neuroma resection: an assessment of complications and payments in a longitudinal administrative database. Cureus 2015; 7 (10) e369
• 9 Rolston JD, Han SJ, Chang EF. Systemic inaccuracies in the National Surgical Quality Improvement Program database: implications for accuracy and validity for neurosurgery outcomes research. J Clin Neurosci 2017; 37: 44-47
• 10 Oravec CS, Motiwala M, Reed K. , et al. Big data research in neurosurgery: a critical look at this popular new study design. Neurosurgery 2018; 82 (05) 728-746
• 11 Bohl DD, Basques BA, Golinvaux NS, Baumgaertner MR, Grauer JN. Nationwide Inpatient Sample and National Surgical Quality Improvement Program give different results in hip fracture studies. Clin Orthop Relat Res 2014; 472 (06) 1672-1680
• 12 Khuri SF. The NSQIP: a new frontier in surgery. Surgery 2005; 138 (05) 837-843
• 13 Sellers MM, Merkow RP, Halverson A. , et al. Validation of new readmission data in the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg 2013; 216 (03) 420-427