An Interrupted Time Series Analysis of 2023 Hernia CPT Revisions and Differential Effects on Private Practice Versus Academic Surgeons.

Abstract

To evaluate the impact of the 2023 Current Procedural Terminology (CPT) coding changes on work relative value units (wRVUs), focusing on practice setting and hernia size. In 2023, CPT codes for ventral hernia repair were revised, eliminating distinctions by surgical approach, consolidating hernia types, and shortening the global period. As reimbursement is linked to wRVUs, these changes may differentially impact practices based on case mix. We conducted a retrospective interrupted time series analysis using the Abdominal Core Health Quality Collaborative registry. Patients undergoing ventral hernia repairs were included if operated on by surgeons with ≥15 cases in both the preintervention (2021-2022) and postintervention (2023-2024) periods, with an inguinal hernia as a concurrent control. Outcomes were quarterly mean wRVUs and the distribution of hernia size (small, medium, and large) by practice type. Among 6181 patients undergoing hernia repairs, academic centers demonstrated increased quarterly mean wRVUs following the 2023 CPT revisions (1.98 per quarter; 95% CI: 1.58, 2.38), whereas nonacademic centers did not, coinciding with more frequent large hernia coding at academic sites. Mean wRVUs for large repairs (>10 cm) increased (1.80; 95% CI: 1.22, 2.39), while small (<3 cm) and medium (3-10 cm) hernias remained stable. The 2023 CPT revisions were associated with higher wRVUs for more complex repairs without decreases for smaller hernia procedures. Academic surgeons repairing larger hernias experienced increased wRVUs postimplementation, while nonacademic surgeons remained stable. These findings highlight the need to monitor how coding changes affect wRVUs and practice patterns.