UPJ INSIGHT Comparison of Work Relative Value Units Assigned to Urological and Gynecological Surgical Procedures

By: Jon K. Hathaway, MD, PhD, Indiana University, Indianapolis; Mitchell S. Schuster, MD, University of Alabama, Birmingham; Kyle A. Richards, MD, University of Wisconsin, Milwaukee; Thomas M. T. Turk, MD, Loyola University Chicago, Illinois | Posted on: 17 Jul 2024

Hathaway JK, Schuster MS, Richards KA, Turk TMT. Comparison of work relative value units assigned to urological and gynecological surgical procedures. Urol Pract. 2024;11(4):654-660. doi:10.1097/UPJ.0000000000000612

Study Need and Importance

Gender pay disparity is well established, and root cause analysis is crucial to its correction. This study examines work relative value units (wRVUs) assigned to analogous procedures performed on women compared to those performed on men using criteria currently used by the American Medical Association Relative Value Scale Update Committee (RUC) to determine if procedures on men are paid more than procedures on women.

What We Found

We reviewed the entire RUC valued procedural code set and identified sex-specific procedures that had an analogous procedure in the opposite sex. These pairs were then evaluated using current RUC methodology to determine if they were comparable. Comparable code pairs values were then examined to determine any differences in the wRVUs assigned between the procedures. The methodology used considered standard RUC procedure including comparing global period, intraservice time, total time, hospital days, postoperative office visits, and the date of the RUC review. Of the 9 directly analogous code pairs reviewed, 6 of the female procedures had higher values (0.29-6.47 wRVU difference), and 3 of the male procedures had higher values (1.23-2.34 wRVU difference). There were no statistical differences in the overall wRVUs, wRVUs per minute of operating room time, and wRVUs per minute of total time (Table). Previous reports did not understand and use the RUC valuation method in comparing sex-specific procedures and thus came to erroneous conclusions.

Table. Directly Analogous Pairs With Similar Conditions for Valuation

CPT code	Descriptor	wRVU	OR time wRVU/min	Total time wRVU/min
53440	Sling operation male urinary incontinence	13.36	0.15	0.05
57288	Sling operation for stress incontinence	12.13	0.20	0.05
53442	Removal or revision of sling for male urinary incontinence	13.49	0.15	0.03
57287	Removal or revision of sling for stress incontinence	11.15	0.19	0.05
51597	Pelvic exenteration for vesical, prostatic, or urethral malignancy	42.86	0.14	0.04
58240	Pelvic exenteration for gynecologic malignancy	49.33	0.12	0.04
55842	Prostatectomy, retropubic radical with nodes	21.36	0.12	0.05
58200	Total abdominal hysterectomy with nodes	23.10	0.15	0.05
55845	Prostatectomy, retropubic radical	25.18	0.13	0.05
58210	Radical abdominal hysterectomy	30.91	0.13	0.05
38780	Retroperitoneal transabdominal lymphadenectomy	17.70	0.09	0.03
58943	Oophorectomy; for ovarian, tubal, or primary peritoneal malignancy	19.52	0.14	0.05
54057	Destruction of lesion(s), penis, simple, laser	1.29	0.04	0.02
56501	Destruction of lesion(s), vulva; simple	1.58	0.11	0.03
54050	Destruction of lesion(s), penis, simple, chemical	1.29	0.09	0.02
55150	Resection of scrotum	8.14	0.10	0.03
56625	Vulvectomy, simple, complete	9.68	0.12	0.03
54700	Incision and drainage of epididymis, testis, and/or scrotal space	3.47	0.11	0.04
56405	Incision and drainage of vulva or perineal abscess	1.49	0.10	0.03
Abbreviations: CPT, Current Procedural Terminology; OR, operating room; wRVU, work relative value units.

Limitations

This study only considered procedures with another procedure done in the opposite sex. It does not consider the whole of procedures performed by different specialties or look at gender-neutral specialties.

Interpretation for Patient Care

Systemic bias in physician payment exists, but wRVU values are not different for analogous, sex-specific procedures.