Overview:
The attached Spreadsheet includes the detail for the following:
Total orthopedic procedures = 1,645
Orthopedic codes without a Site of Service Differential (SOSD)= 1174. 71% of all orthopedic procedures. NON-FAC NA INDICATOR = NA.
These procedures are considered “facility only” and there is no additional reimbursement when performed in an office-based surgical suite(OBSS) (POS=11). When performed in a facility (ASC, HOPD, or hospital) there is a separate facility fee billed and paid to the facility. For this reason, transferring to an OBSS is seen by some insurance companies as preferable as they save money (and the patient saves as well).
Orthopedic codes with a SOSD = 471; 28.6%
These procedures can be performed in the facility or the office and the reimbursement to the surgeon is higher for the office to pay for the OBS “overhead” or NON-FAC PE.
Some procedures (29999: unlisted procedure) do not have any RVU’s.
My mission is to help all surgeons, across all specialties negotiate the “carve-out” for reasonable OBSS reimbursement. This applies to WALANT, and local anesthesia procedures.
I will also be including information on the registration and accreditation issues involved with setting up an OBSS.