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

Area of Science:

• Medical Economics
• Surgical Procedures
• Health Policy

Background:

• Current Procedural Terminology (CPT) codes for anterior abdominal hernia repair were updated in 2023.
• These changes aimed to standardize reimbursement and align with outpatient care trends.
• Potential negative financial impacts on general surgeons were anticipated.

Purpose of the Study:

• To analyze the financial impact of new CPT codes on surgeon and facility reimbursement for anterior abdominal hernia repair.
• To compare reimbursement and work relative value units (wRVUs) before and after the 2023 CPT code changes.

Main Methods:

• A retroactive analysis was conducted at an ambulatory surgery center.
• Surgeon reimbursement data from 2019-2022 (old CPT codes) was compared to 2023 (new CPT codes, including E/M services).
• Procedural work relative value units (wRVUs) were also compared between the periods.

Main Results:

• Average surgeon reimbursement decreased significantly for incarcerated hernia repair (-58.89%) and surgical facility reimbursement for reducible hernia repair (-56.97%) in 2023 compared to 2019-2022.
• Average procedural wRVUs decreased by 25.4% for incarcerated and 45% for reducible hernias post-2023.
• Statistical significance was noted for both findings (p < 0.05).

Conclusions:

• The 2023 CPT code revisions for anterior abdominal hernia repair have led to substantial reductions in surgeon and facility reimbursement.
• These findings suggest a negative financial impact on surgeons performing these procedures.
• Further investigation across larger surgical facilities is recommended to validate these outcomes.