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Significant lowering of hernia surgeon reimbursement and work RVUs due to 2023 CPT coding changes
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Significant lowering of hernia surgeon reimbursement and work RVUs due to 2023 CPT coding changes
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Journal Article
Significant lowering of hernia surgeon reimbursement and work RVUs due to 2023 CPT coding changes
2025
Overview
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.
•Average case reimbursement of incarcerated abdominal hernias decreased by 59 % in 2023 compared to 2019 to 2022 combined.•Change in reducible abdominal hernias repairs decreased by 44% but was not found to be statistically significant.•E/M reimbursement per case was about $165 in 2023.•In 2023, surgeon reimbursement for the repair alone is $248.97 for reducible and $272.70 for incarcerated abdominal hernias.•These CPT code changes are detrimental to surgeons performing abdominal wall hernia repairs.
Publisher
Elsevier Inc,Elsevier Limited
