SIR 2024
Gastrointestinal Interventions
Suraj S. Parikh, MD
Resident
University of Pittsburgh Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Will S. Lindquester, MD
Independent IR Resident
Emory University School of Medicine
Disclosure information not submitted.
Data shows that cholecystostomy tube placement utilization rates increased by 630% from 2000 to 2018, while compensation was nearly halved. Conversely, cholecystectomy utilization rates decreased by 33% during the same period, while compensation increased. Rate changes accelerated following each iteration of the Tokyo Guidelines.1 The most recent iteration of the Tokyo Guidelines was published in 2018 (TG18). This study is to provide an update on cholecystostomy tube placement and cholecystectomy utilization rates and their payments among Medicare beneficiaries from 2019 to 2021 following TG18.
Materials and Methods:
Medicare claims from 2019 to 2021 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.
Results:
Cholecystostomy tube placement rates essentially plateaued from 2019 to 2021 trending up from 12,097 to 12,400 per year. The wRVU for cholecystostomy tube placement was stable at 4.7 for all three years, and total payments per procedure was also relatively stable, going from $271.5 to $273.3.
Cholecystectomy rates decreased in the study period by 17.3% from 182,679 to 151,106. As compared to previously published data, the rates have decreased by 42.2% since reaching peak of 261,739 in 2006. Work RVUs for laparoscopic cholecystectomy have remained stable at 10.47 to 11.47 all three years and the wRVU for the open procedure has remained stable at 17.48 to 18.48 all three years. Compensation for the aggregate has remained relatively stable per procedure from $497.6 to $506.6.
Conclusion:
Cholecystostomy tube placement rates have plateaued from 2019 to 2021. The wRVU and average payment per cholecystostomy tube has remained relatively unchanged. Conversely, cholecystectomy rates have decreased by 17.3% during the same period, with a total decrease of 42.2% since achieving peak in 2006. The wRVU and average payment per procedure has remained unchanged. Rate changes for cholecystectomy have further accelerated following TG18.