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Generating a New CPT Code Set for Adult and Pediatric Appendectomy
Christopher P Childers1,2, Don J Selzer3, Michael L Green4
1Department of Surgery, University of Washington, Seattle.
Insights
This study proposes 16 new Current Procedural Terminology (CPT) codes for appendectomy based on surgeon work, aiming to modernize descriptions for open and laparoscopic procedures. The findings identify distinct patient groups requiring different surgical work levels.
Area of Science:
- Surgical coding and reimbursement
- Health services research
- Medical economics
Background:
- Current Procedural Terminology (CPT) codes for appendectomy have remained unchanged for over 30 years.
- Existing codes may not accurately reflect the physician work involved in modern appendectomy procedures.
- Reassessment of CPT codes could lead to improved accuracy in work relative value units.
Purpose of the Study:
- To provide empirical data for developing a new code structure for appendectomy.
- To identify distinct patient populations with varying surgeon work requirements for appendectomy.
- To inform potential modernization of CPT codes and their descriptions.
Main Methods:
- Retrospective review of US National Surgical Quality Improvement Program (NSQIP) appendectomy-specific files (2021-2023).
- Analysis included adult and pediatric appendectomy cases.
- Surgeon work was measured by operative time, postoperative length of stay, and complication rates.
Main Results:
- A total of 110,379 appendectomy encounters were analyzed.
- Complicated appendicitis was present in 25.9% of cases; open procedures accounted for 2.8%.
- Factors significantly associated with increased surgeon work included complicated disease, extreme age (≤5 or ≥65 years), interval appendectomy, and appendectomy for tumor. Based on these, 16 new codes (8 laparoscopic, 8 open) are proposed.
Conclusions:
- This study presents the first empirical framework for developing new appendectomy CPT codes.
- Objective measures of surgeon work were used to identify distinct patient populations.
- The proposed framework can aid in modernizing CPT codes and descriptions for appendectomy, reflecting current surgical practice.
Importance:
There are 3 Current Procedural Terminology (CPT) codes for appendectomy-2 codes describing open appendectomy with or without peritonitis or abscess and 1 code for laparoscopic appendectomy regardless of presentation-which have remained the same for more than 30 years. It is possible that physician work (assessed in work relative value units) for these codes will eventually need to be reassessed, and this study may provide an opportunity for modernizing the CPT codes and their descriptions.
Objective:
To provide empirical data to determine what a new code structure for appendectomy could look like.
Design, Setting, And Participants:
This cross-sectional study performed a retrospective review of 2021-2023 US National Surgical Quality Improvement Program (NSQIP) adult and pediatric appendectomy-specific files among adults and children undergoing appendectomy. Data analysis was completed in May 2025.
Main Outcome And Measures:
We sought to identify distinct populations of patients that require different levels of surgeon work, which we measured using operative time, postoperative length of stay, and rates of complications.
Results:
The final sample included 110 379 encounters for appendectomy. Approximately one-quarter (28 583 [25.9%]) had complicated disease; only 3057 cases (2.8%) were performed open. Compared to uncomplicated appendicitis in children and adults (aged 6-64 years), we found the following factors were significantly associated with changes (generally increases) in surgeon work using our measures: complicated disease, age 5 years or younger and 65 years or older, and whether the procedure was for interval appendectomy or performed for tumor. Based on these stratifying variables, we propose 16 new codes-8 laparoscopic and 8 open-that identify unique populations of patients undergoing appendectomy with different work profiles.
Conclusions And Relevance:
In this cross-sectional study, we provide the first empirical strategy for identifying new codes for appendectomy using objective measures of surgeon work. If appendectomy ever undergoes review of its relative work, this study provides a potential framework for improving the CPT codes and describing the nuances of appendectomy in the modern era.
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