DiPaola Blake C, Mooney Rachel E, Sairajeev Sasha V, Butler Lance, Plymale Margaret A, Davenport Daniel L, Roth J Scott
From the Department of Surgery, University of Kentucky College of Medicine, Lexington, KY (DiPaola, Mooney, Sairajeev, Plymale, Davenport, Roth).
Department of Statistics, University of Kentucky College of Arts and Science, Lexington, KY (Butler).
J Am Coll Surg. 2025 Mar 1;240(3):263-269. doi: 10.1097/XCS.0000000000001224. Epub 2025 Feb 14.
CPT codes for ventral hernia repair (VHR) changed in January 2023 to address the heterogeneity of procedures with a concomitant shift from a 90- to 0-day global period. This study reviews a tertiary referral center's experience with hernia coding comparing the work relative value units (wRVUs) generated for VHR pre-2023 compared with post-2023.
CPT codes were analyzed for patients undergoing open or laparoscopic VHR before updates to the CPT hernia codes (January 2022 to September 2022) and after CPT change (January 2023 to September 2023). wRVU values were assigned based on nationally published values. CPT codes in 2022, CPT codes in 2023, 8 inpatient evaluation and management (E&M) codes, and 5 outpatient E&M codes were evaluated.
A total of 299 patients underwent VHR, 143 in 2022 and 156 in 2023. Average procedural VHR wRVUs increased from 9.6 in 2022 to 11.6 in 2023 (p < 0.001). Procedures involving myofascial advancement flaps or component separation techniques (53.8% vs 48.7%, p = 0.419) and wRVUs for the component separation procedures were similar between 2022 and 2023, respectively, 17.7 vs 16.1 (p = 0.419). The wRVUs associated with adjunctive procedures (mesh removal or placement) decreased from 3.3 to 0.6 (p < 0.001) in the post-2023 era. Postoperative E&M wRVUs increased in 2023 for postoperative inpatient (0.48) and postoperative outpatient (0.39) services, compared with 0 wRVUs in 2022. Overall, the total management including follow-up clinic visit adjusted wRVUs for hernia repair was similar between 2022 and 2023, respectively 30.7 vs 29.2 (p = 0.409).
Procedural wRVUs for anterior abdominal hernia repair increased from 2022 to 2023 (p < 0.001) at a tertiary referral medical center. However, total wRVUs, including the operation and postoperative visits, remained unchanged.
腹疝修补术（VHR）的现行程序编码术语（CPT）于2023年1月发生变更，以应对手术的异质性，并同时将全球服务期从90天改为0天。本研究回顾了一家三级转诊中心在疝编码方面的经验，比较了2023年之前和之后为VHR生成的工作相对价值单位（wRVU）。
对在CPT疝编码更新之前（2022年1月至2022年9月）以及CPT变更之后（2023年1月至2023年9月）接受开放或腹腔镜VHR的患者的CPT编码进行分析。wRVU值基于全国公布的值进行分配。对2022年的CPT编码、2023年的CPT编码、8个住院评估与管理（E&M）编码以及5个门诊E&M编码进行评估。
共有299例患者接受了VHR，2022年有143例，2023年有156例。VHR手术的平均wRVU从2022年的9.6增加到2023年的11.6（p < 0.001）。涉及肌筋膜推进皮瓣或成分分离技术的手术（53.8%对48.7%，p = 0.419）以及2022年和2023年成分分离手术的wRVU相似，分别为17.7对16.1（p = 0.419）。在2023年之后的时期，与辅助手术（补片移除或放置）相关的wRVU从3.3降至0.6（p < 0.001）。2023年术后住院（0.48）和术后门诊（0.39）服务的E&M wRVU增加，而2022年为0 wRVU。总体而言，2022年和2023年包括随访门诊就诊在内的疝修补术调整后的wRVU总量相似，分别为30.7对29.2（p = 0.409）。
在一家三级转诊医疗中心，2022年至2023年期间前腹壁疝修补术的手术wRVU有所增加（p < 0.001）。然而，包括手术和术后就诊在内的总wRVU保持不变。
