Significant lowering of hernia surgeon reimbursement and work RVUs due to 2023 CPT coding changes

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery Pub Date : 2025-04-02 DOI:10.1016/j.amjsurg.2025.116334

Robert C. Wright , Makena D. Horne , Abigail B. Dayley , Evan K. Bialkowsky

{"title":"Significant lowering of hernia surgeon reimbursement and work RVUs due to 2023 CPT coding changes","authors":"Robert C. Wright , Makena D. Horne , Abigail B. Dayley , Evan K. Bialkowsky","doi":"10.1016/j.amjsurg.2025.116334","DOIUrl":null,"url":null,"abstract":"<div><div>In 2023, changes were made to the Current Procedural Terminology (CPT) codes for anterior abdominal hernia repair to more uniformly reimburse hernia repair and better reflect current practices. These changes were made to address a shift toward the outpatient setting however general surgeons may be negatively impacted. A retroactive analysis of an ambulatory surgery center compared the surgeon's average reimbursement from old CPT codes from 2019 to 2022 to new CPT codes in 2023 including the evaluation and management (E/M) services in the new 0-day global period. Average case reimbursement to the surgeon decreased significantly for incarcerated hernia repair (<em>p</em> = 0.01, −58.89 % change) and to the surgical facility for reducible hernia repair (<em>p</em> = 0.004, −56.97 % change) between the combined average of 2019–2022 and 2023. Average procedural work relative value units for hernias from 2019 to 2022 were found to decrease by 25.4 % for incarcerated and 45 % for reducible hernias compared to 2023. Further evaluation with a larger surgical facility is needed to confirm these findings.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"244 ","pages":"Article 116334"},"PeriodicalIF":2.7000,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American journal of surgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0002961025001564","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}

引用次数: 0

Abstract

In 2023, changes were made to the Current Procedural Terminology (CPT) codes for anterior abdominal hernia repair to more uniformly reimburse hernia repair and better reflect current practices. These changes were made to address a shift toward the outpatient setting however general surgeons may be negatively impacted. A retroactive analysis of an ambulatory surgery center compared the surgeon's average reimbursement from old CPT codes from 2019 to 2022 to new CPT codes in 2023 including the evaluation and management (E/M) services in the new 0-day global period. Average case reimbursement to the surgeon decreased significantly for incarcerated hernia repair (p = 0.01, −58.89 % change) and to the surgical facility for reducible hernia repair (p = 0.004, −56.97 % change) between the combined average of 2019–2022 and 2023. Average procedural work relative value units for hernias from 2019 to 2022 were found to decrease by 25.4 % for incarcerated and 45 % for reducible hernias compared to 2023. Further evaluation with a larger surgical facility is needed to confirm these findings.

查看原文本刊更多论文

由于2023年CPT编码的变化，疝外科医生报销和工作RVUs显着降低

2023年，对现行腹前疝修补程序术语（CPT）规范进行了修改，以更统一地报销疝修补，更好地反映当前的做法。这些变化是为了解决向门诊环境的转变，但普通外科医生可能会受到负面影响。对某门诊手术中心进行回顾性分析，比较了2019 - 2022年旧CPT代码与2023年新CPT代码的平均报销情况，包括新的全球0天期间的评估和管理（E/M）服务。2019-2022年和2023年的综合平均水平相比，嵌顿疝修补手术的平均病例报销费用（p = 0.01，变化幅度为- 58.89%）和可复位疝修补手术设施的平均病例报销费用（p = 0.004，变化幅度为- 56.97%）显著下降。与2023年相比，2019年至2022年疝的平均手术相对价值单位在嵌顿疝中下降了25.4%，在可减轻疝中下降了45%。需要在更大的手术设施中进一步评估以证实这些发现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.