Practice expenses for services provided in a physician’s office include: 1. Clinical Staff Time 2. The Equipment 3. Supplies Typically Used During A Procedure 4. Indirect Expenses Of A Physician Practice Such As Administrative Staff 5. Building Space 6. Office Supplies Considered overhead or “facility fees” whether NON-FAC PE is… Continue reading
This list is our 10-day global procedures with comparable Facility PE RVU’s (7.14) to code 29848. CPT Description Global NON FAC PE RVU FAC PE RVU WORK RVU MALPR TOT NON FAC RVU TOT RVU TOT FAC RVU 58661 Laparoscopy remove adnexa 10 5.71 11.35 1.8 18.86… Continue reading
This is an interesting list. Based on comparable Work RVU’s to ECTR (code 29848) of 6.39 and technically considered “minor surgery” there are significant facility fees associated with most of them—higher in fact than those of our comparable 90-day global list. CPT Description NON FAC PE RVU FAC PE RVU… Continue reading
In our effort to compare and contrast different procedures I analyzed 10-day global procedures. These are generally considered “office” procedures. CPT Description Global NON FAC PE RVU FAC PE RVU WORK RVU MALPR TOT NON FAC RVU TOT RVU TOT FAC RVU 11646 Exc f/e/e/n/l mal+mrg >4 cm 10 7.4… Continue reading
CPT Description Global NON FAC PE RVU FAC PE RVU WORK RVU MALPR TOT NON FAC RVU TOT RVU TOT FAC RVU 24130 Removal of head of radius 90 7.06 6.42 1.21 14.69 29834 Elbow arthroscopy/surgery 90 6.55 6.42 1.22 14.19 58805 Drainage of… Continue reading
The codes listed below have similar facility PE RVU’s to 29848. CPT Description Global NON FAC PE RVU FAC PE RVU WORK RVU MALPR TOT NON FAC RVU TOT RVU TOT FAC RVU 27087 Remove hip foreign body 90 7.15 8.83 1.81 17.79 40527 Reconstruct lip with… Continue reading
Below is a list of CPT codes from the Medicare PFSRVU database that have comparable total RVUs to CPT code 29848: Endoscopic Carpal Tunnel Surgery (ECTR). The Work RVU’s are also similar, most in 6-7 RVU range. CPT Description Global NON FAC PE RVU FAC PE RVU WORK RVU MALPR… Continue reading
Out of 3784 procedures with a 90-day global (major surgery) in the 2020 Medicare PFSRVU database, 3247 or 86% have no Site of Service Differential when performed in the office. All reimbursement is at the facility rate only. I would consider these “facility-only” procedures. The median Site of Service Differential… Continue reading
The list below are 90-day surgeries that have the lowest non-facility Practice Expense RVU’s or reimbursement in the 2020 PFSRVU Medicare database. While still considered “major surgery,” based on the NON-FAC PE these would be considered those that required the lowest overhead costs or risk. There is a likelihood that… Continue reading
The codes listed below are exceptions where the facility practice expense reimbursement (FAC PE) is higher than the non-facility practice expense (NON-FAC PE). I consider these to be backwards because for all the other procedures (over 500) the Site of Service differential is higher for the office facility because there… Continue reading
Below are CPT™ procedures that have the highest Site of Service Differential in the Medicare PFSRVU 2020 database. In other words, if the procedure is performed in the office the Non-Facility RVUs are significantly higher than other procedures. These are extreme examples. However, they illustrate that complex procedures, that may… Continue reading
Relative Value Units (RVUs) are used by Medicare (and private insurance companies) to determine how much physicians are paid for providing healthcare services. Total RVUs have three components. Add to these the GPCI and the Medicare Conversion Rate and there are five elements necessary for accurate reimbursement calculation. These are… Continue reading
This is the different total reimbursement, including both the Professional fees paid the the Physician and a separate payment paid to the facility (ASC, hospital outpatient, or inpatient hospital). It is described with RVU’s, explained in more detail here. Some 90-day surgeries do not have a Site of Service Differential… Continue reading
Surgeries can be performed in different Places of Service (POS) Office: POS=11 Ambulatory Surgery Center: POS=22 Hospital Outpatient: POS=24 Hospital Inpatient: POS=21 Many minor surgeries such as biopsies, lesion removals and simple sutures are 10-day global procedures and routinely performed in the office. Typically a facility is used when the… Continue reading
Known as the Wide-Awake Local Anesthesia No Tourniquet procedure this technique revolutionizes how hand and wrist surgeries are performed for conditions such as: Carpal tunnel syndrome De Quervain’s tenosynovitis Tendon ruptures Trigger finger WALANT is especially beneficial for patients who do not want to or are unable to undergo general… Continue reading
Many hand surgery procedures such as carpal tunnel release, tendon repair and removal of masses can now be performed under local anesthesia alone, avoiding the use of sedation or general anesthesia. The technique—known as Wide-Awake Local Anesthesia, No Tourniquet (WALANT)—can be performed in the surgeon’s office. The ability to safely… Continue reading
That are currently assigned as “facility-only.” These do not have a Site of Service Differential. My name is Jeffrey Restuccio, CPC, COC, I am a reimbursement expert and I’m working on a long-term project with the goal of obtaining appropriate office overhead reimbursement (non-facility physician expense RVU’s or a “facility… Continue reading
For the purpose of this project and analysis there are two types of surgical procedures. Updated Sep 2021. Facility OR office-based Facility-Only 1 Those that can be performed in the office or a facility (ASC, hospital outpatient department [HOPD] or hospital). Considered “Facility-Only”. 2 There is a Site of Service… Continue reading
To our website dedicated to In-Office Carpal Tunnel Release (IOECTR) and Office-Based Surgery (OBS) reimbursement. The focus of this site is to provide a forum for sharing information on office-based surgical procedures, WALANT, and in particular endoscopic procedures of the hand and wrist. The reimbursement advice will be applicable to… Continue reading