Faculty Bibliography

INTRODUCTION/BACKGROUND:Robotic assisted laparoscopic prostatectomy (RALP) is a mainstay in the treatment of prostate cancer. Current procedure terminology (CPT) identifies a case that requires substantially greater effort than usual by using the modifier 22 code (M22). Our objective was to identify the most common etiologies leading to M22 at our institution and determine the effect on perioperative outcomes. MATERIALS AND METHODS/METHODS:We retrospectively reviewed our prostatectomy database from 2009-2012 to identify patients who underwent RALP with and without M22. Reasons for M22 were determined by review of operative reports. Comparisons were made using Chi-square analysis and independent t-tests for continuous data. RESULTS:Of 579 patients identified from our database, 208 (36%) had a M22. Eighty-six (41%) patients had ≥ 2 documented reasons for M22. Adhesiolysis was the most common reason for M22 followed by large prostate and previous hernia mesh. Body mass index (BMI) (29.8 versus 28), prostate volume (53 g versus 44 g), operative time (259 minutes versus 234 minutes), and discharge from hospital with pelvic drain in place (6.7% versus 3%) were all significantly higher in the M22 group. Final pathological stage and positive margin rate were not increased in those with a M22. Complications were not different between those with and without M22. CONCLUSION/CONCLUSIONS:The M22 code is associated with longer operative times, larger prostates, and higher BMI. Adverse effects on final pathological stage, margin status and complications were not found in those with M22. Many patients with a M22 have more than one reason documented as for the explanation of the modifier.

OBJECTIVE:To quantify the effect of the new 2010 World Health Organization (WHO) semen analysis reference values on reclassifying previous semen analysis parameters and definition of patients with male factor infertility. DESIGN/METHODS:A multi-institutional retrospective chart review. SETTING/METHODS:University and private male infertility clinics. PATIENT(S)/METHODS:Men referred for infertility evaluation. INTERVENTION(S)/METHODS:Comparison of semen analysis values based on 2010 versus 1999 reference criteria. MAIN OUTCOME MEASURE(S)/METHODS:Quantification of the change based on individual sperm parameters and as a whole. RESULT(S)/RESULTS:A total of 184 men had at least two semen analyses; 13 (7%), 17 (9.2%), 34 (18.4%), and 29 (15.7%) patients changed classification to being at or above the reference values by the 2010 criteria for semen volume, sperm concentration, motility, and morphology, respectively. A total of 501 men had one semen analysis on file; 40 (7.9%), 31 (6.2%), 50 (9.9%), and 74 (19.3%) would change classification for volume, concentration, motility, and morphology, respectively. Overall, 103 patients (15.1%) who had one or more parameter below the reference value on the original analysis were converted to having all parameters at or above the 2010 reference values. CONCLUSION(S)/CONCLUSIONS:The 2010 reference values result in some infertile men being reclassified as fertile if status is based on semen analysis alone. This may lead to fewer men being referred for proper infertility evaluation or treatment.