Appendix 2
Diagnosis and treatment for medial meniscal tear [knee] - ICD9CM Diagnosis code 836.0 - assessment of costs of finding the same yield of positive
patients
Standard of Care versus VSI diagnosis and treatment paradigm - costs using 2013 reimbursement data
Number of diag. & ther. procedures performed for ICD9CM Diagnosis code
836.0 =
502,200 derived from positive findings (TP and FP) for MRI
Number of diagnostic procedures performed for ICD9CM Diagnosis code
836.0 =
258,709 derived from negative findings (FN and TN) for MRI
Number of diag. & ther. procedures performed for ICD9CM Diagnosis code
836.0 =
468,531 derived from positive findings (TP and FP) for VSI
Number of diagnostic procedures performed for ICD9CM Diagnosis code
836.0 =
291,919 derived from negative findings (FN and TN) for VSI
Procedure code
CPT 99203
Description
Evaluation and management - new patient - 30 minutes
CPT 73560
Xray 1-2 views
CPT 73721
SOC Cost
$108.19
Notes
VSI Cost
$108.19
$32.32
$32.32
Magnetic resonance (eg, proton) imaging, any joint of
lower extremity; without contrast material, non-facility
(RVUs of 11.91) (Global)
$405.21
$0.00
CPT 73721-26
Magnetic resonance (eg, proton) imaging, any joint of
lower extremity; without contrast material, non-facility
(RVUs of 1.96) (Professional component "-26")
$66.69
$0.00
CPT 20610
Arthrocentesis - aspiration or injection major joint or
bursa @ 10% of time for diagnosis (1)
$65.56
$0.00
CPT 29870
Arthroscopy, knee, diagnostic, with or without synovial
biopsy (separate procedure) - nonfacility setting
$0.00
$603.23
1
Notes
CPT 29881
$551.51
$551.51
$131.55
$131.55
Hospital outpatient - knee arthroscopy/surgery
Evaluation and management - existing patient - 30
minutes
Total cost per patient (for positive findings)
Total cost per patient (for neg findings) [diagnostic procedures only)
Number of surgical procedures performed based on diagnostic findings =
Number of people who are medically managed (e.g. PT) due to FN findings=
Number of diag procedures performed based on neg findings =
$2,111.62
$72.81
$2,111.62
$72.81
$3,486.46
$618.97
502,200
91,024
258,709
$3,611.23
$743.74
468,531
27,258
291,919
Total cost to system for diagnosis and treatment (positives) =
Total cost to system for diagnosis of a negative finding =
Cost per patient for medical management [PT](10.6 sessions over 10 wks) =
Number FN patients who have insurance (@85% of FN) =
Total costs to system for medical mgmt (physical therapy) of FN findings on
MRI =
Percent of patients under medical mgmt crossing over to surgery(2)
Number of patients who crossed over (CO) to surgery in FN group =
Cost of FN medical mgmt patients crossing over to surgery =
Number of patients who underwent phys ther post surgical arthroscopy
(@85%) =
Costs for patients under physical therapy post surgery for TP, FP, and FN
results =
Total costs diagnosis and treatment (all positive and negative findings)=
Cost per patient diagnosis & treatment =
$1,750,898,203
$159,847,970
$1,318
77,370
CPT 01440
Arthroscopy, knee, surgical; with meniscectomy (medial
OR lateral, including any meniscal shaving) including
debridement/shaving of articular cartilage
(chondroplasty), same or separate compartment(s), when
performed
General anesthesia (assumes 45 minutes)
APC 0041
CPT 99213
2
$101,941,382
30%
27,307
$74,710,861
450,081
$593,016,082
$2,680,414,497
$3,525
(TP +FP)
(FN)
(FN+TN)
(TP + FP)
(FN+TN)
(FN)
(FN)
(FN CO)
(TP+FP+FN
CO)
(TP+FP+FN
CO)
$1,691,973,203
$217,111,837
$1,318
23,169
$30,527,314
30%
8,177
$21,777,479
(TP +FP)
(FN)
(FN+TN)
(TP + FP)
(FP+TN)
(FN)
(FN)
(FN CO)
(TP+FP+FN
398,251
CO)
(TP+FP+FN
$524,726421
CO)
$2,486,116,254
$3,269
Costs for a complication based on procedure being performed
Complications for arthroscopy procedures
Reoperation (any reason) [includes costs of CPT 29871 & APC 0041]
Venous thromboembolism (VTE) [includes 12 month for treatment]
Deep vein thrombosis (DVT) [includes 12 month for treatment]
Pulmonary embolism (PE) [includes 12 month for treatment]
Number of arthro procedures which complications were applied to =
Occurrence of complications based on incidence and number of procedures
Reoperation (any reason) [includes costs of CPT 29871 & APC 0041]
Venous thromboembolism (VTE)
Deep vein thrombosis (DVT)
Pulmonary embolism
Overall costs for complications
Reoperation (any reason) [includes costs of CPT 29871 & APC 0041] =
Venous thromboembolism (VTE) =
Deep vein thrombosis (DVT) =
Pulmonary embolism =
Total costs complications =
Cost complications per patient for those exposed to arthroscopy =
Total costs - diagnosis, therapeutics, and complications =
Cost differential complications (which costs more and by how much) =
Overall cost per patient =
Incidence
0.30%
0.19%
0.12%
0.08%
Cost/event
$2,633.53
$14,865.00
$14,865.00
$22,900.00
Incidence
0.010%
0.131%
0.083%
0.055%
Cost/event
$2,633.53
$14,865.00
$14,865.00
$22,900.00
529,593
1,237,158
1,589
1,006
636
424
124
1,623
1,025
684
$4,183,419
$14,955,137
$9,445,349
$9,700,572
$38,284,477
$72
$2,718,698,975
$177,232,047
$3,575
$325,809
$24,131,344
$15,240,849
$15,652,671
$55,350,674
$45
$2,541,466,927
$3,342
Footnotes:
(1) National Ambulatory Medical Care Survey data 2010 - 10% figure based on 2010 figures for arthrocentesis for meniscal knee injury (100,000/970,000 =
10%)
(2) Katz JN, et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis. NEJM2013; DOI: 10.1056/NEJMoa1301408
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