Hip arthroscopy in the United States: an update following coding changes in 2011

Abstract

The purpose of this study is to define the incidence of hip arthroscopy-related procedures in the United States prior to and following 2011 and to determine if the rise in incidence has coincided with an increase in the complexity and diversity of procedures performed. Patients who underwent hip arthroscopy were identified from a publicly available US database. A distinction was made between 'traditional' and 'extended' codes. CPT-29999 (unlisted arthroscopy) was considered extended and counted only if associated with a hip pathology diagnosis. Codes directed toward femoroacetabular impingement pathology were also considered extended codes and were analyzed separately based on increased technical skill. Unpaired student t-tests and z-score tests were performed. From 2007 to 2014, there were a total of 2581 hip arthroscopies performed in the database (1.06 cases per 10 000 patients). The number of hip arthroscopies increased 117% from 2007 to 2014 (P < 0.001) and 12.5% from 2011 to 2014 (P = 0.045). Hip arthroscopies using extended codes increased 475% from 2007 to 2014 (P < 0.001) compared to 24% for traditional codes (P < 0.001). Codes addressing femoroacetabular impingement (FAI) pathology increased 55.7% between 2011 to 2014 (P < 0.001). The ratio of labral repair to labral debridement in patients younger than 50 years exceeded >1.0 starting in 2011 (P < 0.001). The total number of hip arthroscopies in addition to the complexity and diversity of hip arthroscopy procedures performed in the United States continues to rise. FAI-based procedures and labral repairs are being performed more frequently in younger patients, likely reflecting both improved technical ability and current evidence-based research.

Figures

Fig. 1.

Incidence of hip arthroscopy stratified by age (years) from 2007 to 2014. The highest incidence of hip arthroscopy was in patients 15–24 years of age, followed by 35–44 years of age.

Fig. 2.

Incidence of hip arthroscopy based on category and percent change from 2007 to 2014. The graph demonstrates the increase in hip arthroscopy between 2007 and 2014. With the introduction of billing codes for more extended procedures, particularly FAI and labral repair, in 2011, there was an initial drop in traditional procedures followed by a small, gradual rise in traditional procedures, though still lower than its peak in 2010. On the other hand, extended procedures rose with the introduction of the new codes and have continued to rise or stay steady since 2012.

Fig. 3.

Incidence and percent change in billing of extended codes. This graph suggests that many of the unlisted codes had been related to FAI prior to 2011, as reflected by the decrease in that code following the introduction of new codes in 2011. While femoroplasty and labral repairs continue to be performed more frequently since the introduction of those codes, acetabuloplasty has declined after an initial increase in incidence.

Fig. 4.

Number of patients undergoing labral repair and labral debridement by year. Labral surgery has continued to increase in incidence, with labral repair being performed more commonly than labral resection.

Fig. 5.

Number of patients with FAI-related codes compared to CPT–29999 (Unlisted). With the introduction of the FAI codes, the incidence of recorded FAI surgery has continued to rise. The use of unlisted codes in hip arthroscopy has also increased, although much less frequently, likely reflecting the development of new techniques that lack specific coding, such as capsular plication or closure, decompression of ischiofemoral space, sciatic nerve endoscopy and labral reconstruction, and performance of other procedures, such as iliopsoas lengthening, microfracture, trochanteric bursectomy and gluteus tendon repair.