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Introduction <p>Accurate documentation of hernia size is essential for appropriate clinical management and reimbursement. Recent changes to Medicare codes, which link payment to hernia size, have raised concerns about potential shifts in reporting practices. This study aims to evaluate whether these changes impacted reported hernia dimensions.</p> Methods <p>A retrospective review of prospectively collected data from the Abdominal Core Health Quality Collaborative (ACHQC) was performed to include all adult patients who underwent ventral hernia repairs in the years 2022 and 2023. Analysis of Variance (ANOVA) was performed as part of the generalized linear regression models to evaluate the overall significance of each predictor variable in explaining variance in hernia size. We analyzed operative approach as the secondary endpoint. Statistical analysis was performed using R Statistical Software version 4.2.3.</p> Results <p>Among 11,191 adult patients undergoing ventral hernia repair (5,431 in 2022; 5,760 in 2023), median hernia size—including area, width, and length—was significantly higher in 2023. After adjusting for BMI, gender, surgical approach, and comorbidities, surgery year remained independently associated with larger hernia dimensions. Specifically, reported hernia area increased by 8.1&#xa0;cm² (95% CI: 2.66–13.68, <i>p</i> = 0.004); significant predictors included BMI, female gender, diabetes mellitus, hypertension, and COPD (all <i>p</i> &lt; 0.001). Reported hernia width increased by 0.3&#xa0;cm (95% CI: 0.10–0.50, <i>p</i> = 0.004), with BMI, female gender, open approach, and presence of comorbidities as significant predictors (all <i>p</i> &lt; 0.001). Reported hernia length increased by 0.7&#xa0;cm (95% CI: 0.47–1.06, <i>p</i> &lt; 0.001), with similar predictors. These findings persisted across all adjusted models.</p> Conclusion <p>An increase in reported hernia dimensions was observed following the 2023 Medicare reimbursement updates, which may suggest a shift in documentation practices. While improved measurement cannot be ruled out, the consistency across outcomes supports an association between reimbursement structure and clinical reporting.</p>

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Has the reported average hernia size changed in the last year as a result of the change in medicare reimbursement codes?

  • 期刊论文

  • 发表日期：

    2025年10月14日

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  • Diego L Lima,
  • Raquel Nogueira,
  • Maria Clara Morais,
  • Sofia Wagemaker Viana,
  • Augusto Graziani e Sousa,
  • Xavier Pereira,
  • Flavio Malcher

摘要

Introduction

Accurate documentation of hernia size is essential for appropriate clinical management and reimbursement. Recent changes to Medicare codes, which link payment to hernia size, have raised concerns about potential shifts in reporting practices. This study aims to evaluate whether these changes impacted reported hernia dimensions.

Methods

A retrospective review of prospectively collected data from the Abdominal Core Health Quality Collaborative (ACHQC) was performed to include all adult patients who underwent ventral hernia repairs in the years 2022 and 2023. Analysis of Variance (ANOVA) was performed as part of the generalized linear regression models to evaluate the overall significance of each predictor variable in explaining variance in hernia size. We analyzed operative approach as the secondary endpoint. Statistical analysis was performed using R Statistical Software version 4.2.3.

Results

Among 11,191 adult patients undergoing ventral hernia repair (5,431 in 2022; 5,760 in 2023), median hernia size—including area, width, and length—was significantly higher in 2023. After adjusting for BMI, gender, surgical approach, and comorbidities, surgery year remained independently associated with larger hernia dimensions. Specifically, reported hernia area increased by 8.1 cm² (95% CI: 2.66–13.68, p = 0.004); significant predictors included BMI, female gender, diabetes mellitus, hypertension, and COPD (all p < 0.001). Reported hernia width increased by 0.3 cm (95% CI: 0.10–0.50, p = 0.004), with BMI, female gender, open approach, and presence of comorbidities as significant predictors (all p < 0.001). Reported hernia length increased by 0.7 cm (95% CI: 0.47–1.06, p < 0.001), with similar predictors. These findings persisted across all adjusted models.

Conclusion

An increase in reported hernia dimensions was observed following the 2023 Medicare reimbursement updates, which may suggest a shift in documentation practices. While improved measurement cannot be ruled out, the consistency across outcomes supports an association between reimbursement structure and clinical reporting.