Trends in Epidemiology and Reimbursement for Nerve Exploration and Reconstruction After Brachial Plexus Injury in the United States From 2009 to 2019.

Purpose: Brachial plexus injury (BPI) is an uncommon peripheral nerve disorder with a multitude of treatments. Given the relative rarity of this condition, it is difficult to estimate the volume of primary and secondary reconstructive procedures in the United States, as well as demographic and geographic trends in treatment. Methods: The study used a large administrative commercial insurance claims database to estimate the total volume of procedures associated with a diagnosis of BPI from the years 2009 to 2019. Unique Current Procedural Terminology codes were tabulated among beneficiaries with a known diagnosis of BPI and stratified by key variables including age, sex, and geographic region to assess for trends in diagnosis and management. Reimbursement data for specific Current Procedural Terminology codes were adjusted for inflation and evaluated over the follow-up period. Results: The incidence rate of nerve procedures for BPI increased over the study period from 1.26 to 1.91 procedures per 100,000 patient-years, as did the incidence rate of unique patients with BPI treated with nerve procedures, from 0.76 to 1.18. More procedures were performed in the age group 18-34 years (35.1%) and the South geographic region (40.6%). The most common codes included brachial plexus neuroplasty (Current Procedural Terminology codes 64713 and 64861; 64% of total). Reimbursement increased for codes related to brachial plexus neuroplasty over the interval of +26% and decreased for both neuroplasty of peripheral nerves (-23.9%) and nerve transfers (-39.7%). Conclusions: The volume of procedures performed for BPI continues to increase with the dissemination of surgical techniques and knowledge. Relative increases in the older adult patient population, among females, and in the South necessitate a patient-specific approach given that historically most treatment has been provided to young, male patients. Declining reimbursement for certain codes necessitates continued advocacy given the complexity of surgery and technical advances in the field. Type of study/level of evidence: Differential diagnosis/symptom prevalence IV.