Endoscopic skull base surgery practice patterns: survey of the North American Skull Base Society

Background: The objective of this study was to evaluate the potential impact of advanced endoscopic techniques on the current practice patterns in skull base surgery.

Methods: A 20-item written survey approved by the American Rhinologic Society (ARS) and North American Skull Base Society (NASBS) was conducted at the 22nd Annual NASBS meeting in Las Vegas, NV, from February 17 to 19, 2012. The target group included 212 practicing skull base surgeons.

Results: Seventy-nine physicians (37.3%) completed the survey. The subspecialty composition was 42 (53%) otolaryngologists and 35 (44%) neurosurgeons. The respondents represented all regions of the country, with most common being the North Central (24%) and Mid-Atlantic (23%) states. Open and endoscopic skull base techniques were used by 91% and 80%, respectively. During a typical year, the number of endoscopic skull base cases ranged between 20 and 50 in 32%, 50 to 100 in 13%, and >100 in 8%. Endoscopic pituitary surgery was performed by 95%, while transcribriform, transplanum, and transclival approaches were performed by 70.5%, 66%, and 66%, respectively. Wide variation in coding philosophy was noted, including use of unlisted neurosurgical (28%), open skull base (28%), unlisted endoscopic (24%), and sinus surgery (20%) codes. Only 30% of physicians reported adequate reimbursement in ≥50% of the performed cases. Overall, 87% were supportive of the creation of dedicated endoscopic skull base codes.

Conclusion: The present survey attests to the widespread adaptation of endoscopic techniques in the management schema of skull base surgery. The wide variation in coding techniques and inadequate reimbursement suggests that future dialogue should also focus on developing consensus with respect to the coding and billing process.