The percentage of sacroiliac fusions done in the U.S. by non-surgical specialties has increased.

Abstract

Background: Surgical fusion of the sacroiliac (SI) joint is often performed to manage chronic lower back or buttock pain. When Current Procedural Terminology (CPT) codes were introduced, SI joint fusion procedures were done primarily by orthopaedic surgeons and neurosurgeons. The purpose of this study was to examine the utilization of SI joint fusion CPT codes by physician specialty over time.

Methods: A retrospective cohort study was conducted using the PearlDiver database. The database was queried using CPT codes to identify patients who underwent SI joint fusion via percutaneous, open, or trauma codes. Specialties queried included surgical specialties (orthopaedic surgery and neurosurgery) and non-surgical specialties [physical medicine and rehabilitation (PM&R), neurology, anesthesiology, pain medicine]. Total number and number per year of SI joint fusion procedures were identified for each specialty group. Trends of SI fusion billing for the years 2015 to 2021 were compared between surgical specialties and non-surgical specialties.

Results: Comparing 2015 and 2021, the SI fusion codes submitted across all three groups (percutaneous, open, and trauma) increased for non-surgical specialties compared to surgical specialties. Between 2015 and 2021, the total number of percutaneous procedures submitted by all specialties increased by 294%, while the number of procedures being submitted by non-surgical specialties increased by 25,050%.

Conclusions: Our study demonstrated how quickly and to what degree the procedure market can react to higher work relative value unit (RVU) value codes. Despite requiring less overall time and utilizing an intra-articular rather than a transfixing approach, non-surgical specialties submitted the same CPT code as surgical specialties performing the transfixing procedure at an increasing rate during the study period. With the introduction of new technologies to perform SI fixation and a new code to capture the intra-articular procedure, future studies could examine whether the number of SI fusion procedures performed by the various physician specialties stabilizes over time.