Comparing the Relative Value of Elective and Traumatic Hand Surgery Procedures.

Abstract

The resource-based relative value scale and its working relative value units (wRVUs) is a common model for surgeon compensation. The number of wRVUs per Current Procedural Terminology (CPT) code has been negotiated considering the degree of time, skill, and labor associated with each procedure, across all operative stages. The authors aimed to quantify and elucidate the rate of wRVUs per minute of elective compared with traumatic hand surgical procedures. The authors included elective and traumatic hand surgery cases from a single academic institution between October 1, 2015, and July 1, 2023. Average operative duration and wRVU/min rates were calculated for CPT codes with at least 10 occurrences. Centers for Medicare & Medicaid Services data were used to estimate expected values for the same procedures. CPT 29848 (endoscopic carpal tunnel release) had the greatest earning rate, at 0.80 wRVUs/min. CPT 26350 (flexor tendon repair, not in zone 2) had the lowest rate, at 0.09 wRVUs/min. Elective procedures had an average wRVU/min rate that was more than twice the rate for traumatic procedures (0.34 versus 0.15 wRVU/min; P < 0.001). Traumatic cases had a negative correlation between wRVU/min rate and intraoperative time (r = -0.56; P = 0.04). Despite the complexity and urgency of trauma procedures, the authors found a significantly lower average wRVU/min rate for traumatic compared with elective hand surgical procedures. These results highlight the need for discussion of RVU valuation of traumatic hand surgical procedures.