Standards & Criteria

About the Listings

If you know the type of procedure you want or need, you’re halfway to a solution!

In the USA, there are more than 59,000 unique surgical procedures that have been described by the official guide to Current Procedural Terminology (CPT®) developed, maintained, and copyrighted by the American Medical Association. They have published this industry standard directory of surgical procedures since 1966. In each category, procedures are described using a 5-digit unique code and  there is also one “catchall” code for each subcategory ending in XXX99 for procedures that have not yet been added to that year’s directory. 

One reason to use the -99 code is because the procedure varies enough from the unique published code that it deserves special analysis and interpretation.  Another reason to use the code is to avoid having to type a bunch of medical words that you may not know how to spell or pronounce.  You can ask any surgeon’s office, hospital or free-standing surgery center for the code that is most closely associated with the procedure you need to begin your comparison shopping.  

People who explain and interpret and use the codes are usually certified as Certified Coding Specialists. Most are employed by hospitals, freestanding surgery centers and medical clinics. A certified coding specialist, also referred to as a medical coder or health information technician, is a medical professional responsible for overseeing patient records and ensuring bills are sent to insurance companies with the accurate description of what services were rendered. Certified coding specialists have associate’s degrees in medical billing and coding, and they earn certification through the American Health Information Management Association (AHIMA). They are detail-oriented professionals with good communication and analytical skills and the ability to use medical software programs.  SurgeryShoppers.com verifies codes submitted by providers on our site are a correct for the procedures and prices advertised before we publish them.

We verify that the package prices are transparent and comparable to others using the same procedure code listed in our directory. 

About the Facilities and Providers

Before we list any provider’s information, or allow them to participate in our directory, we pre-qualify that they meet or exceed our rigid internal standards.

SurgeryShopper.com pre qualifies each hospital, freestanding surgery center (ASC) and the surgeons, anesthesiologists and allied health providers who participate in the surgical cases at the facilities by initially and periodically verifying license and accreditation status, professional liability insurance coverage, and a few other key data such as physician and surgeon Board-Certification.

Vetting of all providers includes primary source verification. That means, we check with the state in which they are licensed to verify the license status and history.

We have reviewed the accreditation standards of the prestigious healthcare accrediting bodies that meet our criteria. We verify each providers’ current accreditation status and renewal dates with that accrediting body.  Some accrediting bodies don’t meet our criteria for inclusion, so while the facility may advertise that it is accredited, if the accreditor is one we don’t recognize, the hospital, clinic or free-standing surgery will not be among those listed on our site.

We also verify transfer agreements between freestanding surgery centers and full service hospitals.  A written hospital agreement between two health care institutions for the transfer of patients from one to another and the orderly exchange of pertinent clinical information on the patients transferred in the event of a complication or an emergency.

Finally, we review infection rates and complications rates of each facility. In order to qualify for payment by state and federal insurance programs,  To get payment from Medicare, hospitals are required to report data about some infections to the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN). Health facilities currently submit information on central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), surgical site infections (SSIs), Methicillin-resistant Staphylococcus Aureus (MRSA) blood infections, and Clostridium difficile (C. diff.) intestinal infections. The public reporting of these data is assigned to the U.S. Department of Health and Human Services to make healthcare safer. We verify what they indicate on their application with what has been reported to the NHSN.  CDC provides training for NHSN users in standard surveillance methods. However, adherence to those standard methods varies from hospital to hospital, which may account for some inter-facility differences in the quality and completeness of the reported data. Validation programs are the primary means for addressing variation in data quality.

We also follow updates and alerts and if a provider listed in our directory is implicated in any alert, they are immediately placed on pended status until the matter is cleared up to our satisfaction.

Complication rate for hip/knee replacement patients

The hip/knee replacement complication rate is an estimate of complications within an applicable time period, for scheduled surgery  for primary total hip and/or knee replacement.

We monitor for certain indicators related to 1 of 8 complications that occurs within a specified time period:

  • Heart attack (acute myocardial infarction [AMI]), pneumonia, or sepsis/septicemia/shock during the index admission or within 7 days of admission;
  • Surgical site bleeding, pulmonary embolism, or death during the index admission or within 30 days of admission; or
  • Mechanical complications or peri-prosthetic joint infection (PJI) and surgical wound infection within 90 days of the procedure.

Medicare chose to measure these complications within the specified times because complications over a longer period may be impacted by factors outside the hospitals’ control like other complicating illnesses, patients’ own behavior, or other care services patients received after they leave the hospital. This measure is separate from the serious complications measure (also reported on Hospital Compare).

Due to recent reports shared at the American Academy of Orthopedic Surgeons meeting in 2019, we now also include consideration and note the altitude of the surgery facility and recovery location if they are located at or above 4000′ ASL.