E. C. Poli1, F. S. Dahdaleh1, S. Sherman1, K. K. Turaga1 1University Of Chicago,Department Of Surgery,Chicago, IL, USA
Introduction: Surgeon reimbursement for procedures depends on billing for work relative value units (wRVUs), which are assigned based on current procedure terminology (CPT) codes. Often, different CPT codes can describe similar procedures, with large differences in WRVUs. This potentially creates incentives to perform and code for the higher-WRVU procedure. This study sought to examine whether evidence of such upcoding exists.
Methods: Yearly frequencies of CPT codes for similar but differentially-reimbursed procedures were determined from NSQIP Participant Use Data Files from 2012 to 2015. Included codes and WRVUs were: 47100-wedge biopsy of liver (12.91 WRVU); 47120-hepatectomy/partial lobectomy (39.01 WRVU); 49560-repair initial incisional hernia, reducible (11.92 WRVU); 49561-repair initial incisional hernia, strangulated or incarcerated (15.38 WRVU); 49565-repair recurrent incisional hernia, reducible (12.37 WRVU); 49566-repair recurrent ventral hernia, incarcerated or strangulated (15.53 WRVU); 49568-implantation of mesh for open incisional hernia repair (4.88 WRVU); 15734-component separation repair (19.86 WRVU). CPTs listed under primary CPT, additional CPT and concurrent CPT were counted for each procedure. To account for increasing volume and additional hospitals captured in the database in subsequent years, the proportion of each CPT per year was compared using Fisher’s exact test.
Results: Over the four years, there were 155,790 hernia repairs and 18,875 liver resections of the CPT codes of interest. The proportion of liver resections coded as partial hepatectomies compared to wedge liver biopsies increased over the four years from 60.42% to 64.51% (p value <0.0001). In ventral hernia repairs, the proportion of procedures coded as component separation and repair of initial strangulated or incarcerated incisional hernia, (both with higher WRVU), increased (8.21% to 10.09% and 12.38% to 14.21% respectively, p<0.0001 for heterogeneity).
Conclusion: For the procedures included, there was a small increase in use of CPTs linked to higher WRVUs during the study period.