From the Department of Surgery (Mustansir, Jajja, Lovasik, Sharma, Lin, Sweeney, Sarmiento), Emory University, Atlanta, GA.
Winship Cancer Institute (Sarmiento), Emory University, Atlanta, GA.
J Am Coll Surg. 2023 May 1;236(5):993-1000. doi: 10.1097/XCS.0000000000000609. Epub 2023 Feb 3.
CPT coding allows addition of a 2-digit modifier code to denote particularly difficult procedures necessitating additional reimbursement, called the modifier 22. The use of modifier 22 in relation to pancreatic surgery and outcomes, specifically pancreaticoduodenectomy (PD), has not been explored.
All PDs performed from 2010 to 2019 at a quaternary healthcare system were analyzed for differences in preoperative characteristics, outcomes, and cost based on the use of modifier 22. Adjusted logistic regression analysis was used to identify factors predictive of modifier 22 use.
A total of 1,284 patients underwent PD between 2010 and 2019; 1,173 with complete data were included, of which 320 (27.3%) were coded with modifier 22. Patients coded with modifier 22 demonstrated a significantly longer duration of surgery (365.9 ± 168.4 vs 227 ± 97.1; p < 0.001). They also incurred significantly higher cost of index admission ($37,446 ± 34,187 vs $28,279 ± 27,980; p = 0.002). An adjusted multivariable analysis (specifically adjusted for surgeon variation) revealed duration of surgery (p < 0.001), neoadjuvant chemotherapy (p = 0.039), class II obesity (p = 0.019), and chronic pancreatitis (p = 0.005) to be predictive of modifier 22 use.
Despite the subjective nature of this CPT modifier, modifier 22 is an appropriate marker of intraoperative difficulty. Preoperative and intraoperative characteristics that lead to its addition may be used to further delineate difficult PDs.
CPT 编码允许添加两位数字的修饰符代码，以表示需要额外报酬的特别困难的程序，称为修饰符 22。尚未探讨修饰符 22 与胰腺手术和结果的关系，特别是胰十二指肠切除术（PD）。
对 2010 年至 2019 年在一家四级医疗机构进行的所有 PD 进行了分析，根据修饰符 22 的使用情况，比较了术前特征、结果和成本的差异。使用调整后的逻辑回归分析来确定预测修饰符 22 使用的因素。
2010 年至 2019 年期间共有 1284 例患者接受了 PD；纳入了 1173 例完整数据，其中 320 例（27.3%）编码有修饰符 22。编码有修饰符 22 的患者手术时间明显更长（365.9±168.4 与 227±97.1；p<0.001）。他们的索引入院费用也明显更高（$37446±34187 与 $28279±27980；p=0.002）。经过调整的多变量分析（特别是针对外科医生差异进行调整）显示，手术时间（p<0.001）、新辅助化疗（p=0.039）、II 级肥胖（p=0.019）和慢性胰腺炎（p=0.005）是修饰符 22 使用的预测因素。
尽管该 CPT 修饰符具有主观性，但修饰符 22 是术中困难的适当标志物。导致其添加的术前和术中特征可用于进一步描述困难的 PD。
