Evaluating Postoperative Follow-Up in Total Hip and Knee Arthroplasty: A Six-Year Review of Current Procedural Terminology Code 99024 and the Role of Comorbidity in Visit Frequency.

Abstract

The Centers for Medicare and Medicaid Services assumes two postoperative follow-up visits (PFUs) occur within the 90-day global period after total joint arthroplasty, forming the basis for reimbursement. However, recent concerns suggest this may underestimate actual postoperative care, raising questions about potential overvaluation of these procedures. This study evaluated the frequency of PFUs during the 90-day global period for total knee arthroplasty (TKA) and total hip arthroplasty (THA) and to identify at-risk patients for three or more PFUs during the global period. We queried a national claims database to identify 102,564 and 61,423 patients who underwent TKA and THA between 2017 and 2022, respectively. PFUs (CPT 99024) within 90 days were tracked. Patients were stratified into low-risk (one to two visits) and high-risk (3+ visits) groups. Sociodemographic and clinical variables were collected. Chi-square analysis and multivariate regression models were used to assess the association between comorbidities and follow-up visit frequency. The average number of PFUs for both TKA and THA was 2.20 (SEM 0.004; 95% CI [2.19 to 2.20]; P ≤ 0.001) and 2.06 (SEM 0.005; 95% CI [2.05 to 2.07]; P ≤ 0.001), respectively. A total of 28% of the patients required three or more visits, particularly those with a higher Elixhauser Comorbidity Index and other specific comorbidities such as chronic kidney disease, pulmonary disease, heart disease, blood loss anemia, and obesity. This study reports that a large portion of total joint arthroplasty patients required more than two PFUs during the 90-day global period. High-risk patients who had complex comorbidities necessitated more frequent follow-ups, suggesting an increase in work value be added to the current global billing structure to better account for resource demands. The data presented in this study will be used by the American Association of Hip and Knee Surgeons in future discussions regarding the potential further reduction of PFUs from two to one.