To The Editor:
As Vitale et al. suggest in the Discussion section of their article, "The Rising Incidence of Acromioplasty" (2010;92:1842-50), the reasons for an increased number of acromioplasties is likely multifactorial and may not represent a true rise in the "incidence" of this procedure.
This article indeed shows that there has been a rising incidence of coding for acromioplasties over the last decade. However, a combination of factors, including advances in shoulder surgery and anesthesia, changes in International Classification of Diseases, Revision 9 (ICD-9) and Current Procedural Terminology (CPT) codes, and requirements by the American Board of Orthopaedic Surgery (ABOS) and insurers have all played an influential role.
In part, a shift in the surgical technique for repairing the rotator cuff has occurred in the last decade—from "all open" to "combined open and arthroscopic" to "all arthroscopic." The data acquired from the New York Statewide Planning and Research Cooperative System (SPARCS) database included only information from hospital and freestanding ambulatory surgery centers. In the late 1990s and early 2000s, many open rotator cuff repairs were done on an inpatient or "observation" basis. Therefore, the SPARCS data has been disproportionately impacted by this fact compared with the ABOS data.
Additionally, through the late 1990s and 2000s, changes in CPT coding for shoulder surgery led to so-called unbundling of acromioplasty (arthroscopic and open surgery) from the previous global open codes for rotator cuff repair. This fact alone may have led to a dramatic "increase" in the coding for acromioplasties over the study period.
Finally, as insurance reimbursements have decreased and the ABOS has required more stringent record keeping, there may be more pressure on orthopaedic surgeons to bill multiple codes for a given procedure.
Through ongoing research and increased subspecialization of young orthopaedists by means of fellowship training, the indications for acromioplasty will be better defined.