Cleft Procedures Undervalued Relative to Craniofacial Procedures

TUESDAY, March 7, 2023 (HealthDay News) -- The current relative value unit (RVU) system undervalues cleft procedures versus craniofacial procedures performed by plastic surgeons, according to a study published online Feb. 24 in Plastic and Reconstructive Surgery.

Danielle H. Rochlin, M.D., from the New York University Grossman School of Medicine in New York City, and colleagues queried the National Surgical Quality Improvement Program Pediatric database to identify all cleft and craniofacial surgery cases performed by plastic surgeons from 2012 to 2019. The mean efficiency, defined as total RVUs divided by total operative time, per Current Procedural Terminology (CPT) code was ranked and compared by quartile.

Sixty-nine CPT codes with 50,450 cases were included in the sample. The researchers found that most CPT codes in the top quartile were craniofacial procedures, including frontofacial procedures (23.53 percent) and craniectomies for craniosynostosis or bony lesions (35.29 percent; mean, 15.65 RVUs/hour). Most CPT codes in the lowest quartile were for cleft procedures, including surgeries for velopharyngeal insufficiency, cleft palate repair, and cleft septoplasty (17.65, 23.53, and 5.88 percent, respectively; mean, 7.39 RVUs/hour). Compared with secondary palatal lengthening, it was 2.5 times more efficient for a cleft and craniofacial surgeon to perform a local skin flap for a cleft palate (15.18 versus 6.09 RVUs/hour).

"The current RVU allocation system undervalues cleft surgical services relative to craniofacial procedures," the authors write. "The authors encourage the Relative Value Scale Update Committee to further study the disparities in value highlighted in our analysis, and to advise the Centers for Medicare & Medicaid Services accordingly in an effort to achieve equitable RVU-based compensation and professional advancement."

Abstract/Full Text