JAMA Surg. 2025 Aug 20. doi: 10.1001/jamasurg.2025.2951. Online ahead of print.
ABSTRACT
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.
PMID:40833763 | DOI:10.1001/jamasurg.2025.2951
