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