This one-page graphic illustrates how leverage works using a sample point system. It also illustrates the difference between asking the carrier to cooperate and provide their total costs versus the clinic cost-accounting approach to determining your request amount. These are great for meetings or discussions with a cross-functional team. I… Continue reading
These are based on the level of care rendered. Each facility class has minimal equipment required on site. Class A facility: Provides for minor surgical procedures performed under topical, local, or regional anesthesia without preoperative sedation. Excluded are intravenous, spinal, and epidural routes; these methods are appropriate for Class B… Continue reading
Level I Office Surgery includes, but is not limited to minor procedures such as excision of skin lesions, moles, warts, cysts, lipomas and repair of lacerations or surgery limited to the skin and subcutaneous tissue performed under topical or local anesthesia not involving drug-induced alteration of consciousness other than minimal… Continue reading
While the information below refers to ASC’s it also applies to office-based surgical suites subject to state guidelines. For roughly 15 states (2021) level 1 anesthesia level does not require accreditation or state regulation; regulations change often so always confirm with your state medical board. AAAASF (American Association for Accreditation… Continue reading
As promised this is an in-depth look into IOECTR, WALANT, and OBS. It was updated Sept 2, 2021 My goal with this guidebook is to provide information on how to set up and be fairly reimbursed for In-Office Endoscopic Carpal Tunnel Release (IOECTR). In other words, how to set up… Continue reading
Below is a one-page Spreadsheet for establishing and obtaining reasonable reimbursement for an Office-based-surgical suite, WALANT and/or In-Office Endoscopic Carpal Tunnel Release. Last update: JAN 2022. This checklist is to help surgeons who perform endoscopic carpal tunnel release in the office setting (POS=11 / office) negotiate optimal reimbursement. Related terms… Continue reading
This is specifically for procedures that do not have a Site-of-Service Differential! There are at least 97 hand-and-wrist procedures so this applies to many procedures, not just IOECTR. This is a Step-by-Step Guide on strategies and approaches to negotiating a “carve-out” reimbursement for In-Office Endoscopic Carpal Tunnel Release with an… Continue reading
Overview: The attached Spreadsheet includes the detail for the following: Total orthopedic procedures = 1,645Orthopedic 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… 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
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