Practice Patterns of Surgical Approaches for Pituitary Tumors across Otolaryngologists and Neurosurgeons between 2010 and 2018

Introduction: Endoscopic transsphenoidal approaches are increasingly common for pituitary surgical approaches. With improved access and technology provided by the endoscopic approach, otolaryngologists have become more involved in assisting in these procedures. However, the frequency with which otolaryngologists assist in surgical access is largely unknown. This study sought to better understand otolaryngology involvement and associated payment based on surgical approach for pituitary tumor resection.

Methods: A retrospective cross-sectional analysis between 2010 and 2018 was conducted using publicly available Medicare Physician/Supplier Procedure Summary Data to analyze otolaryngologist and neurosurgeon involvement in pituitary resection surgery. We extracted the total number of surgeries as defined by Common Procedural Terminology (CPT) codes for the transcranial approach (61546), microscopic approach (61548), and endoscopic approach (62165). Similarly, we extracted allowed charges (e.g., Medicare payment) for these approaches. Finally, CPT modifier codes including modifiers 62, 80, 82, and modifier GC were analyzed to better understand team dynamics between otolaryngologists and neurosurgeons during the cases. For each study year, we characterized both the total number of services provided and overall payment by either neurosurgeons alone or both neurosurgeons and otolaryngologists across the three surgical approaches. We adjusted all payment amounts by annual rates of change in the work relative value unit (RVU) conversion factor to reflect 2018 Medicare dollars. We then calculated compound annual growth rates (CAGR) to describe trends in the utilization of pituitary surgical services and payments based on surgical approach.

Results: A total of 29,771 surgeries were performed over the study period, with an associated $268.9 million in Medicare payments. The majority (54.5%) of cases were performed through the endoscopic approach and increased in use (CAGR 11.2%) over the study period. The microscopic approach was performed in 43.7% of cases and decreased (CAGR –6.2%) over the study period. Overall, otolaryngologists were involved in 34.1% of total cases with increased involvement of CAGR 3.7%. For endoscopic cases, otolaryngologists were involved in 66% of cases, with increased involvement (CAGR 12%) over the study period. Modifier 62 was billed in 96.7% of all cases otolaryngologists were involved in. The average otolaryngologist reimbursement for endoscopic approach was $8,681 and increased over the study period (CAGR 7.9%).

Conclusions: Both the endoscopic endonasal transsphenoidal approach for pituitary resection surgery as well as collaboration with otolaryngology in the endoscopic approach increased over the span of the study period. Otolaryngologists most frequently represented their involvement through the modifier 62 co-surgeon code. Payment for otolaryngologists increased at an overall CAGR 7.9% over the study period.

Publication History

Article published online:
01 February 2023