How to increase your RVUs?

[Ergamer]

Couple things I have noticed in this thread that are not accurate. The rules change constantly and each year something is removed or added. Pulse Ox no longer is billable according to my billing companies coders. STEMI that leaves the ER in 29 or less minutes is also not CC, the time stops when the patient leaves the department no matter of follow up phone calls, talking with late arriving family or documenting...This will be nailed as fraud or an audit. Document CPR time, this is the highest billable procedure we perform, it pays by the documented minute (higher than CC time). Watch out for your community or hospital standard on US/XR billing. We have had the argument for years of we are making decisions on our interpretation of the XR and should be able to bill, but get stricken down with the rad groups contract states they are the "exclusive providers of imaging" for the hospital and our billing would violate this. I am aware of some groups charging the rad group for all images not read within an hour to capture the lack of night coverage. After all whose going to court of that xr variance the next day. Same holds with Ortho, if you bill the "definitive fracture care" they have the ability to send them back to you for follow ups, the extra few bucks is not worth the lost political capital with your community orthopedists.

Buried in this thread was the best advice, go see another patient. One of my mentors who was always at the top of his group told me one day, show up 10 minutes early and see one patient before your shift starts, you will inflate your productivity and your partner you are relieving will love you for it. Show up 10 seconds late and they never forget.

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[jumponit]

Hi everyone,

Love the thread, wanted to see if anyone had any updated info or recommendations for 2014 on maximizing RVUs!

 

[Perrin]

Another question. Some folks have posted that 3 nebs in an asthmatic or COPD is CC. Does an hour long neb count as 3 unit dose nebs and this CC?

 

[Daiphon]

Another question. Some folks have posted that 3 nebs in an asthmatic or COPD is CC. Does an hour long neb count as 3 unit dose nebs and this CC?

Provided you appropriately document frequent reevals, thus proving you indeed did spend significant 1-on-1 with the patient, then yes it does (according to our coders).

Heck, combative patients in 4-points also meet the requirements, and I include CC time on those charts (again, at the recommendation of our coders).

Cheers!
-d

 

[upchit]

If you have time, ear cerumen removal increases rvus as well. It can just be with a curette and otoscope. Think it is 0.6 RVU, and its a way to capture work if you have to clear an ear to see the TM for an ear pain complaint.

 

[namethatsmell]

Note templates and macros can be useful to maintain proper documentation. Simple tips like not forgetting critical care time and documenting smoking cessation discussions can boost RVUs immensely.

http://tinyurl.com/lm3onvg

Remember if you didn't document it, it didn't happen.

ok.

we. all. get. it.

really.

please STOP spamming for your template site.

 

[Birdstrike]

Ever told a patient to stop smoking? It's billable by any provider, any specialty:

CPT 99406

Diagnosis code 305.1: Tobacco use disorder

Document 3-10 minutes spent counseling.


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[Birdstrike]

Provided you appropriately document frequent reevals, thus proving you indeed did spend significant 1-on-1 with the patient, then yes it does (according to our coders).

Heck, combative patients in 4-points also meet the requirements, and I include CC time on those charts (again, at the recommendation of our coders).

Cheers!
-d

Critical care is way under billed. Any patient with abnormal vital signs (corrected or not correctable) at any point should get you thinking about this code.

A fib RVR with presenting heart rate of 140, drip started? Consider it.

SVT, with initial HR of 180, adenosine pushed? May not "feel" critical but you should think about this code.

Presenting BP of 80/65 dehydration, 2 liters NS bolused, abnormal vitals stabilized and corrected, but admitted?

Pneumonia, initial sat of 86%, stabilized on O2 mask, cultures drawn, IV meds given, admitted?

Pretty sick. Abnormal vitals. Think about it.


STEMI? Always (as long as spent 30 min in department).

Any life or even limb threat.



What seems easy, or doesn't "feel" critical to you (since "emergencies" are routine to you because you're an ER doctor) may be completely billable as critical care according to the billing and coding world. Don't sell yourself short.

Bill aggressively (within the guidelines, of course). If you are at all payed based on RVUs or productivity, an intimate knowledge of billing and coding can significantly affect your take home.

 

[Daiphon]

Bill aggressively (within the guidelines, of course). If you are at all payed based on RVUs or productivity, an intimate knowledge of billing and coding can significantly affect your take home.

Ding ding ding.

As GI Joe said every day - now you know, and knowing is half the battle.

 

[Droperidol]

Pretty nice little breakdown of RVUs for certain procedures:
http://www.acep.org/uploadedFiles/A...ment_Syllabi/09 Granovsky_Don't Get Stuck.pdf

 

[deleted547339]

STEMI? Always (as long as spent 30 min in department).

I thought it was total time spent exclusive of procedures, in the dept or not. i.e. time spent ordering labs, time charting, time talking to cards, time on the phone with EMS. Sure, they may only be in the dept for 10 mins, but it doesn't seem unreasonable to bill 30min crit care time for a STEMI from that perspective. Am I wrong in my understanding of crit care billing?

 

[RustedFox]

Anyone feel like listing a resource or two that lists the most frequent CC-billable situations?

I'd post one, but I don't have one.

 

[USCDiver]

Here is a list of potential critical care diagnoses and clinical situations sent to use from out billing company (MedData)

 

[daveyjwin]

Here is a list of potential critical care diagnoses and clinical situations sent to use from out billing company (MedData)

This is excellent. As somebody going to a full Fee For Service place next year, and never really having been taught these types of things, I'm going to study this closely. Any comments from anybody else regarding the validity / use of this?

 

[TooMuchResearch]

This is excellent. As somebody going to a full Fee For Service place next year, and never really having been taught these types of things, I'm going to study this closely. Any comments from anybody else regarding the validity / use of this?

I would like to point out that "formeprizole" is not an intervention for ethylene glycol ingestion in my part of the country. That certainly doesn't mean anything else on this list is incorrect or that the list is incomplete.

 

[Birdstrike]

Pretty nice little breakdown of RVUs for certain procedures:
http://www.acep.org/uploadedFiles/A...ment_Syllabi/09 Granovsky_Don't Get Stuck.pdf

I have a comment: check out the awesome road rash on the cyclist on slide 34. Yum.

 

[EMGrad2016]

Bump!

Anyone know of any conferences/ lectures/ CME geared toward increasing RVUs?

 

[bravotwozero]

ACEP billing and coding conference in Palm Springs


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[martvubo]

I work as a scribe for a CMG and wondered if there would be any interest in breaking down what actually goes into our coding. A lot of these rules of thumb are kind of helpful but some of it is overkill and might make you work harder documenting that you need to.

 

[migm]

Anyone talking about MIPS at their group..?

 

[heroesinahalfshell]

I know it has been asked before I didn't see a clear answer, in regards to splints, is it sufficient to put in a post splint/neurovascular check to get full credit for the splint or do you need to actually place the splint?

 

[suckstobeme]

Question:
Would you bill critical care for alcohol intoxication? I work in a college town and I legitimately get lots of kids that do not open their eyes to verbal command and do not obey commands and have confused responses (ie GCS 11). Is it legit or sketchy? I already put them in "Observation"status.

Assume eval, documentation, and 2 reassessments take 30ish minutes.

 

[Daiphon]

Question:
Would you bill critical care for alcohol intoxication? I work in a college town and I legitimately get lots of kids that do not open their eyes to verbal command and do not obey commands and have confused responses (ie GCS 11). Is it legit or sketchy? I already put them in "Observation"status.

Assume eval, documentation, and 2 reassessments take 30ish minutes.

Routinely do. Frequent reassessment with acute intoxication to ensure no respiratory nor CNS decompensation meet criteria.

Semper Brunneis Pallium

 

[RustedFox]

Question:
Would you bill critical care for alcohol intoxication? I work in a college town and I legitimately get lots of kids that do not open their eyes to verbal command and do not obey commands and have confused responses (ie GCS 11). Is it legit or sketchy? I already put them in "Observation"status.

Assume eval, documentation, and 2 reassessments take 30ish minutes.

Routinely do. Frequent reassessment with acute intoxication to ensure no respiratory nor CNS decompensation meet criteria.

Semper Brunneis Pallium

I'm sooo doing this. How many reassessments for legit billing? Two?

 

[shoal007]

I'm sooo doing this. How many reassessments for legit billing? Two?

i personally go by feel. if im concerned enough to keep the drape open, thinking about them frequently or they have oxygen desaturation, they're getting critical care billed. I am usually reassessing them far more than 2x, but i think that is reasonable.

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[canigetawhatwhat]

Cc for every afib rvr, neonatal sepsis, severe sepsis, dka, pe, nstemi.

 

[Daiphon]

I'm sooo doing this. How many reassessments for legit billing? Two?

I usually do at least 3. Seems easier to claim 30-45 min of time that way. More if *really* plowed.

Semper Brunneis Pallium

 

[heroesinahalfshell]

Do you guys bill cc for every septic patient? Or just severe sepsis and worse?

 

[canigetawhatwhat]

Do you guys bill cc for every septic patient? Or just severe sepsis and worse?

Severe only.

 

[TrumpetDoc]

Do you guys bill cc for every septic patient? Or just severe sepsis and worse?

It's really not black and white thing, nor is it diagnosis driven.
If you're rechecking them, and have a halfway decent MDM sepsis works every time.

 

[deleted109597]

There is a reason the FM docs bill higher CC rates than we do.
It's because we don't follow the rules as well. We think "nah, that's not critical" but the government does.
As mentioned before, asthma with 3 nebs (or 1 hour of continuous), check. Anything requiring continuous or titratable drips (NTG, cardene, diltiazem, nitroprusside, insulin, methylene blue, crofab, etc).
Metabolic derangements other than DKA, such as thyrotoxicosis. Anything requiring positive pressure ventilation that isn't OSA such as: COPD, asthma, CHF.
HyperK and hypoK for that matter. We EPs underbill by a lot as a group.

 

[gamerEMdoc]

I highly recommend taking a coding course. AAEM has one as a pre-conference course some years. I took it a few years ago. It was one day, and I came out of there understanding billing/coding insanely well. Coding isnt hard, but its boring as hell to sit down and read and figure out on your own. Is it necessary to take a course? No, of course not. But I guarantee you it will be some of the best money you ever spent if you have any productivity reimbursement tied to your compensation.

 

[heroesinahalfshell]

I highly recommend taking a coding course. AAEM has one as a pre-conference course some years. I took it a few years ago. It was one day, and I came out of there understanding billing/coding insanely well. Coding isnt hard, but its boring as hell to sit down and read and figure out on your own. Is it necessary to take a course? No, of course not. But I guarantee you it will be some of the best money you ever spent if you have any productivity reimbursement tied to your compensation.

Are there any other conferences that people have gone to that have been worth while? I definitely need to attend one.

 

[RustedFox]

Can anyone recommend a web-based coding course? I find that I learn with these the best. I hate having to "go" to some lecture where the speaker is marginal and there's no alcohol.

 

[deleted109597]

Can anyone recommend a web-based coding course? I find that I learn with these the best. I hate having to "go" to some lecture where the speaker is marginal and there's no alcohol.

There's always alcohol. Sometimes you just have to BYOB.

 

[HunterGatherer]

a day of lectures? I c

Can anyone recommend a web-based coding course? I find that I learn with these the best. I hate having to "go" to some lecture where the speaker is marginal and there's no alcohol.

What he said. Alcohol is cool too.
I keep seeing that course you're talking about and keep thinking there has to be a condensed version of this. I remember as a med student the ER rotation I was in had a coding guy come in and do a talk for one hour. It was not complete but an awesome start. I still have that handout somewhere 8 years later.