Procedure Valuation: How a Code Becomes an RVU and a Review of the Current Literature

The goal of this review is to describe the complex process by which a procedure code is assigned value using relative value units (RVUs) and discuss current research that assesses the objectivity and equity of the process.

While research on this topic is somewhat limited, the authors of a majority of studies call for revaluation of common codes within their surgical specialty due to misvaluation when comparing current RVU scales with national procedure time data. In addition, several studies report that the current system does not adequately reflect patient-based factors that influence physician workload during a case. Finally, certain small subspecialties and pediatric subspecialties in surgical fields are particularly vulnerable to misvaluation.

Procedure valuation is critically important for surgeons to understand to ensure advocacy for their field and their patients. Continued research using large, national datasets will provide evidence for needed improvements in objectivity in this process and increased surgeon participation in this committee-based decision is imperative for equitable change.