PURPOSE To estimate ophthalmologist-level variation in cataract surgery billing and evaluate patient and ophthalmologist characteristics associated with complex cataract surgery coding. SETTING Cross-sectional study. DESIGN Retrospective case series. METHODS Medicare beneficiaries aged 65 years or older who had cataract surgery between January 1, 2016, and December 31, 2017, were included. Billing of cataract surgery as complex versus routine and patient and physician characteristics associated with billing of cataract surgery as complex were evaluated. RESULTS An estimated 3.5 million cataract procedures were performed on Medicare beneficiaries in 2016 and 2017. Men (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.75-1.82), patients 75 years or older (versus those aged 65 to 74 years: OR, 1.35; 95% CI, 1.33-1.36), and racial minorities (blacks versus whites: OR, 1.80; 95% CI, 1.75-1.85) had increased odds of having cataract surgery coded as complex. The mean rate of coding for complex cataract surgery by individual surgeons (n = 10 075) in the United States was 11.2%, with significant variation. A high-risk clinical diagnosis code was associated with 40.0% of complex cataract surgeries. Adjusted for patient characteristics, ophthalmologists who graduated from medical school within the past 10 years (OR, 1.35; 95% CI, 1.22-1.49) were more likely to code for complex cataract surgery. Higher volume ophthalmologists were less likely to code for complex cataract surgery than low-volume ophthalmologists. CONCLUSIONS There was marked variation among ophthalmologists in the use of complex cataract surgery. Some variability might represent inaccurate coding and was not entirely based on differences in referral patterns for more complex patients.

中文翻译：

---

对于Medicare受益人而言，白内障手术的收费与常规相比是复杂的。

目的评估白内障手术账单上的眼科医生水平变化，并评估与复杂白内障手术编码相关的患者和眼科医生特征。设置横断面研究。设计回顾案系列。方法纳入2016年1月1日至2017年12月31日期间接受白内障手术的65岁或65岁以上的Medicare受益人。对复杂的白内障手术计费与常规比较以及与复杂的白内障手术计费相关的患者和医师特征进行了评估。结果在2016年和2017年，估计对Medicare受益人进行了350万例白内障手术。男性（优势比[OR]为1.79； 95％置信区间[CI]为1.75-1.82），75岁以上的患者（65岁以上的患者）至74岁：OR，1.35； 95％CI，1.33-1.36），和少数族裔（黑人与白人：OR，1.80； 95％CI，1.75-1.85）将白内障手术编码为复杂病例的几率增加。美国个别外科医生（n = 10075）进行复杂白内障手术的平均编码率为11.2％，差异很大。高风险的临床诊断代码与40.0％的复杂性白内障手术相关。根据患者特征进行调整后，过去10年内从医学院毕业的眼科医生（OR为1.35； 95％CI为1.22-1.49）更可能为复杂的白内障手术编码。与小容量的眼科医生相比，大容量的眼科医生不太可能为复杂的白内障手术编写代码。结论在复杂的白内障手术中，眼科医生之间存在显着差异。