The attached spreadsheet, a much shortened version of the 2021 Medicare PFSRVU file, includes only 2021 Hand and Wrist Orthopedic Procedures with no SOSD in the following categories: Flexor And Extensor Tendon Repair Tendon Transfer Dupuytren Contracture Release Trigger Finger And Carpal Tunnel Release Surgical Treatment Of Metacarpal And Phalangeal… Continue reading
Below are 2021 charges for Code 29848 and 64721. Reimbursement Information Wrist Endoscopy / Surgery Carpal Tunnel Surgery (Open) CPT™ Code: 29848 64721 PFS Relative Value Units: 15.12 12.37 Medicare Allowable (Physician Services Fee): $490.04 $446.43 Facility Fee Payment Weight: ASC: 14.7803 16.6878 Facility Fee Reimbursement: ASC: $723.53 $796.79 Facility… 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
One Visio Graphic is a one-page IOECTR Project Overview The other is a one-page graphical representation of the issues. These include OBS, WALANT, SOSD, reimbursement, setup, accreditation and others. Also included is a more-detailed one-page explanation of the issues above.
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
Leverage: Identify your clinic’s leverage before entering negotiations with a health plan. How many surgeons perform ECTR in your city? Unique Services: Does your practice offer any unique services that will benefit the health plan and its members? Patient Mix: An OBS / WALANT clinic can accept patients not appropriate… Continue reading
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
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
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