Recognizing Variations in Primary Palatoplasty Billing: A Review of 9827 Cases

Objective: Identify unbundling trends in primary palatoplasty.

Design: Retrospective study utilizing the American College of Surgeon Pediatric National Surgical Quality Improvement Program (PNSQIP).

Setting: Records available from 2016 to 2021.

Patients: All patients with primary CPT (current procedural terminology) code 42200 (palatoplasty for cleft palate, soft and/or hard palate only).

Interventions: Cohorts compared "unbundled": additional CPT code 42235 (repair of anterior palate, including vomer flap) vs. "bundled": 42200 billed alone.

Main outcome measures: Operative time, surgical specialty, and other perioperative variables.

Results: In total, 9827 had primary CPT 42200. Of these, 671 (6.8%) were unbundled. Operative time was longer in unbundled (157.08 min vs. 133.16 min; P < .001). Plastic surgeons were less likely to unbundle (6.2% vs. otolaryngology, 9.12%; P < .001).

Conclusions: Variations in primary palatoplasty billing exist. Longer operative times in unbundled cases suggest added complexity. Undervaluation of craniofacial CPT codes may contribute to non-standard billing practices.