Are procedures worth it?

[chickensoupdr]

For those in private practice doing EMG/NCS, how does doing procedures fit into your schedule, work balance, and meeting RVU's. Is it worth it?

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[Postictal Raiden]

I don’t do EMGs but I can tell you that they are worth it. Look up the RVUs generated from doing neuro diagnostics using this link:

https://www.aan.com/siteassets/home-page/tools-and-resources/practicing-neurologist--administrators/billing-and-coding/medicare-fee-for-service/medicare-2023-physician-fee-schedule.pdf

Doing a two limb EMG generates about 5 total RVUs. NCS also adds more RVUs are these are often done in the same session. Many neurologists also bill a follow up visit on top of that. This can all be done in 30-45 mins. That’s a lot more RVUs generated than only relying on E&M RVUs from seeing patients.

 

[Telamir]

I think the physician work component is what you want to be looking at. Which is 1.something. The total rvu is also meant to cover some overhead I think.

 

[Postictal Raiden]

I think the physician work component is what you want to be looking at. Which is 1.something. The total rvu is also meant to cover some overhead I think.

Good point
That’s why if you ever join a group, make sure to claim part of the pie (profit sharing). The physician component for routine eeg is a small fraction of the total collection. Although some of the money is going to pay the tech and cover the expense of the equipment, the lion share is lining the pockets of the practice owners.

 

[JumpingLumberjacksofMaine]

This is 2015-2019 data; I don't think it's changed that much for EMG though.

If you do an hour/study without tech, definitely not worth it UNLESS you keep some of the technical component (which is pretty rare in employed settings). The professional component of the RVU's means that you are essentially losing productivity vs just seeing clinic patients (I think it's tilted even more in favor of clinic visits with changes since 2019).

If your in private practice and keep all of the technical component, then it is still worth it--the actual pay is about twice what you see with patients from what I've heard.

TLDR: EMG/NCS is worth it if you're in private practice, or if you're employed plus use a tech, have managed to negotiate keeping some of the technical component, or can do around a study/30 mins (which is actually pretty rare without churning out hot garbage).

Or just if you enjoy doing them and realize you're taking a bit of a loss.

 

[Spinothalamic]

If you are truly private practice then would highly recommend procedures. It’s hard to make average neurology salary in private practice without doing quite a few procedures unless you aren’t spending enough time with patients and providing likely substandard care or have lots of ancillary income streams. One simple single limb 30-minute EMG with insurance pays for more than a new complex Medicare patient that took up 70 minutes. In general NCS/EMGs pay for around twice as much as seeing patients.

In the same way one Botox procedure for migraine pays for more than a level 4 return (up to 39 min) and may take 10 min.

As you know procedures in medicine are reimbursed so much better than seeing patients which is an unfortunate disincentive

Just look up the actual reimbursement in the physician fee lookup schedule for your locality and compare things. 95911 may be standard NCS for bilateral upper limb study with 2 95886.
It’s a cruel reality

The fact is that “is it worth it” is so backwards in truly private practice. The right question is “is it worth it” to be in private practice neurology without procedures.

 

[Neurogeneral]

EMG can pay decently if you have at least two machines that you can cycle though.

I managed to get a per diem EMG job where i come in a few days per month at a facility. I do about 10-11 EMGs and i get paid a flat rate of $3000. We have 2-3 techs available and 2-3 machines - so I think theres plenty of margin still to increase the number of EMGs.

 

[JumpingLumberjacksofMaine]

300/study, with a tech???? Wow! Nice work!!

Hopefully everybody learns from my stupidity.

As an employed doc I only thought in terms of wRVU, not dollars. It was only after a few years that I thought to ask why private practice docs were so eager to do EMG's when I was doing EMG's at a loss.

If you are employed, you should either have a tech doing the study or you should get some of the technical component. Something to balance the fact that, for a given amount of time spent clinic wRVU and EMG wRVU's are about equal (or even a little skewed in favor of clinic visits) but $/clinic visit pays about half the $/EMG.

 

[neurolddoc]

I can speak only from the perspective of a private practice physician/business owner. Procedures with technicians generates much more income per unit of physician time than E&M codes.

For an EEG, the technician cost would be about $50 including salary and benefits. The equipment is amortized used over a large number of studies and pe r test cost is negligible. Reimbursement depending upon insurance and geographic location can be 450–$700. How long does it take for you to read and report an EEG?

An EMG/NCV study with 7–8 nerves and 2 extremity EMG will reimburse 300–400. It costs 1/2-hour of tech time plus what ever time it takes for the physician to do the EMG.

Carotid duplex/transcranial Doppler reimburse substantially more than the tech time required and interpretation takes minimal physician time.

Bottom line is that for a physician in private practice, testing allows the physician to generate revenue based on the efforts of employed technicians at a substantial profit.