Ayuso Sullivan A, Anderson Derrius, Rwigema Jean-Christophe, Opel Elliot, Kuchta Kristine, Hedberg H Mason, Ujiki Michael B, Linn John G
Division of Gastrointestinal & General Surgery, Department of Surgery, Endeavor Health, Evanston, IL, USA.
Grainger Center for Simulation and Innovation, Evanston Hospital, Room B665, 2650 Ridge Ave, Evanston, IL, 60201, USA.
Surg Endosc. 2025 Jul 21. doi: 10.1007/s00464-025-11987-9.
In 2023, new current procedural terminology (CPT) codes were introduced for anterior abdominal wall hernias based on hernia size, reducibility, and recurrence. When insurance prior authorization is required for hernia repair, it is necessary to estimate the size of the hernia to provide the appropriate CPT code. The aim of this study is to determine whether or not preoperative physical exam (PE) and imaging accurately predict the intraoperative size and thereby CPT code.
A prospectively maintained, single-institution hernia database was queried for patients undergoing elective incisional hernia repair from 2023 to 2024. Hernia size from most recent preoperative PE and CT scan within six months of surgery (if available) were compared to the intraoperative size. The percent congruence was determined between preoperative PE/CT and operative size/CPT code. Standard descriptive statistics were used.
145 patients underwent incisional hernia repair during the study period. One quarter (24.8%) of the hernias were recurrent and 11.7% were incarcerated. Preoperatively, 59.3% of patients had a CT scan available for review and 74.5% of patients had size documented on PE. Mean defect size was 5.5 × 5.3 cm by CT, 6.1 × 4.9 cm by PE, and 10 × 5.8 cm by intraoperative measurement (p < 0.01). In 46.9% of cases, the CPT code was different than that predicted on PE or CT; 97.2% of these discordant patients had hernias that are larger than predicted, and 43.4% had multiple smaller defects noted in the operative report.
Since the inception of the 2023 hernia CPT update, greater than four in ten patients had an operative CPT code that did not match the CPT code predicted on PE and CT. When CPT incongruence existed, hernia size intraoperatively was frequently larger than predicted and was associated with swiss cheese defects. A larger hernia CPT code may lead to increased out-of-pocket cost for patients who require preauthorization.
2023年，基于疝的大小、可复性和复发情况，引入了用于腹壁前疝的新现行程序编码（CPT）。当疝修补术需要保险预先授权时，有必要估计疝的大小以提供合适的CPT编码。本研究的目的是确定术前体格检查（PE）和影像学检查能否准确预测术中疝的大小，从而确定CPT编码。
查询一个前瞻性维护的单机构疝数据库，以获取2023年至2024年接受择期切口疝修补术的患者信息。将手术前六个月内最近一次术前PE和CT扫描（如有）测得的疝大小与术中大小进行比较。确定术前PE/CT与手术大小/CPT编码之间的一致百分比。使用标准描述性统计方法。
在研究期间，145例患者接受了切口疝修补术。四分之一（24.8%）的疝为复发性疝，11.7%为嵌顿性疝。术前，59.3%的患者有CT扫描结果可供查看，74.5%的患者在PE中记录了疝的大小。CT测得的平均缺损大小为5.5×5.3cm，PE测得的为6.1×4.9cm，术中测量的为10×5.8cm（p<0.01）。在46.9%的病例中，CPT编码与PE或CT预测的不同；在这些不一致的患者中，97.2%的疝比预测的大，43.4%的患者在手术报告中发现有多个较小的缺损。
自2023年疝CPT更新以来，超过十分之四的患者手术CPT编码与PE和CT预测的CPT编码不匹配。当CPT不一致时，术中疝的大小通常比预测的大，并且与“瑞士奶酪”样缺损有关。对于需要预先授权的患者，较大的疝CPT编码可能会导致自付费用增加。
