ECT practices and wRVU 2.5% decrease?

[samac]

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I can’t find anything specific on ECT, but since it’s not an E&M or time based code I assume it’s going to fall in with all the procedures getting a 2.5% rate reduction every 3 years?

ECT is already crap for RVUs at 2.5/session. In my hospital we’re required to do it in an OR so I can’t get more than a case done every 45 minutes.

Are there any add ons for ECT I’m unaware of?

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[nexus73]

I know you can't add on psychotherapy codes to to ECT

 

[Ironspy]

When I do ect in the pacu or outpatient we do 3-4 cases per hour. It’s hard to imagine an efficient system using an OR. If you have a wait list you can consider pitching an idea to admin to change to pacu ECT to improve access

 

[samac]

When I do ect in the pacu or outpatient we do 3-4 cases per hour. It’s hard to imagine an efficient system using an OR. If you have a wait list you can consider pitching an idea to admin to change to pacu ECT to improve access

I have tried so hard discussing this because it’s so inefficient, but the folks who control the OR/PACU space will not allow it. Code carts not being readily accessible, and not having a high enough number of anesthesia providers to be able to rotate through 2 of them to go case to case are the reasons. I hate doing ECT because it is such an inefficient use of my time.

I know you can't add on psychotherapy codes to to ECT

sure! Wouldn’t that be nice though?

 

[Stagg737]

I have tried so hard discussing this because it’s so inefficient, but the folks who control the OR/PACU space will not allow it. Code carts not being readily accessible, and not having a high enough number of anesthesia providers to be able to rotate through 2 of them to go case to case are the reasons. I hate doing ECT because it is such an inefficient use of my time.


sure! Wouldn’t that be nice though?

Why do you need 2 anesthesiologists to rotate? Just have 1 who is dedicated for that morning. Tbf, we do ECT in our PACU and it’s still horribly inefficient. Usually takes 2-2.5 hours to do 4 cases, which like you is largely because of OR/PACU staff policies.

 

[samac]

Why do you need 2 anesthesiologists to rotate? Just have 1 who is dedicated for that morning. Tbf, we do ECT in our PACU and it’s still horribly inefficient. Usually takes 2-2.5 hours to do 4 cases, which like you is largely because of OR/PACU staff policies.

Anesthesia stays with them much longer than I’d expect them yo tbh. They’re usually with them until the or flips.

 

[Merovinge]

Anesthesia stays with them much longer than I’d expect them yo tbh. They’re usually with them until the or flips.

It's a self-manufactured problem. I've seen ECT done at several hospitals and zero of them do it in the OR, always in a PACU. A surgery center OR might be able to pull it off as those are designed for efficacy from the ground up. It's always 1 gas assigned to the cases for the few hours they run. It's still a bad use of the psychiatrists time, as you probably get in 5 cases for around 2 hours in the morning. There are some rare high volume setups I have heard of that do say 10 patients/day that can get through 3+ per hour where everyone works as a team and does it consistently.

 

[Atreides]

It's a self-manufactured problem. I've seen ECT done at several hospitals and zero of them do it in the OR, always in a PACU. A surgery center OR might be able to pull it off as those are designed for efficacy from the ground up. It's always 1 gas assigned to the cases for the few hours they run. It's still a bad use of the psychiatrists time, as you probably get in 5 cases for around 2 hours in the morning. There are some rare high volume setups I have heard of that do say 10 patients/day that can get through 3+ per hour where everyone works as a team and does it consistently.

Yeah, setup makes a huge difference. When I was in residency, we had two separate ECT services. One was at our university Hospital, and we saw, on average, one case an hour, in the OR. Sometimes a little more but not by much. Anesthesia was whichever CRNA or anesthesiologist drew the short straw that day. At the private (semi-academic) facility though, they were going through 12 to 15 in a half day and had a dedicated ECT suite with their own anesthesiologist.

 

[calvnandhobbs68]

It's a self-manufactured problem. I've seen ECT done at several hospitals and zero of them do it in the OR, always in a PACU. A surgery center OR might be able to pull it off as those are designed for efficacy from the ground up. It's always 1 gas assigned to the cases for the few hours they run. It's still a bad use of the psychiatrists time, as you probably get in 5 cases for around 2 hours in the morning. There are some rare high volume setups I have heard of that do say 10 patients/day that can get through 3+ per hour where everyone works as a team and does it consistently.

Lol even the VA does it in PACU when I rotated there. Sorry your hospital is just ridiculous OP. I'm also surprised they don't want to use the OR for, you know, anything else that actually makes money?

 

[samac]

Lol even the VA does it in PACU when I rotated there. Sorry your hospital is just ridiculous OP. I'm also surprised they don't want to use the OR for, you know, anything else that actually makes money?

I agree!
I was promised a dedicated ECT suite a couple years ago but budget cuts lost that

 

[Stagg737]

I agree!
I was promised a dedicated ECT suite a couple years ago but budget cuts lost that

I feel your pain. When I was the ER psychiatrist I was promised that phase 2/3 of ER remodel was going to include a psych area with a dedicated workroom for the ER psychiatrist within my first year. 3.5 years after it was promised, 3 ER psychiatrists later, and after Phase 1 was promptly completed, Phase 2 is on indefinite hold and no longer includes a psych workroom and phase 3 has no timeline.

 

[nexus73]

We do ECT in a procedure room near where they do endoscopies and infusions, so nurses are used to quick turnaround procedures. We can do about 2 treatments per hour barring delays. Treating in the PACU would definitely improve efficiency but I guess they don't have the space to allocate for us.

RVU wise if they are outpatients you can bill a 99213 or 99214 outpatient code plus the ECT code, so you get around 3.8 - 4.4 RVUs per case, so nearly 8-9 per hour if treating two patients. If they are inpatient you can only bill the ECT code unless you are also the attending treating them that day which may not be the case.

Interestingly, though not surprisingly, I believe Medicare increased the facilty fee for ECT January 2025, but the RVU value remained the same. So hospital is getting paid more.

 

[samac]

We do ECT in a procedure room near where they do endoscopies and infusions, so nurses are used to quick turnaround procedures. We can do about 2 treatments per hour barring delays. Treating in the PACU would definitely improve efficiency but I guess they don't have the space to allocate for us.

RVU wise if they are outpatients you can bill a 99213 or 99214 outpatient code plus the ECT code, so you get around 3.8 - 4.4 RVUs per case, so nearly 8-9 per hour if treating two patients. If they are inpatient you can only bill the ECT code unless you are also the attending treating them that day which may not be the case.

Interestingly, though not surprisingly, I believe Medicare increased the facilty fee for ECT January 2025, but the RVU value remained the same. So hospital is getting paid more.

Wait hold up you can bill for an outpatient visit and the procedure?
I had no idea

 

[samac]

We do ECT in a procedure room near where they do endoscopies and infusions, so nurses are used to quick turnaround procedures. We can do about 2 treatments per hour barring delays. Treating in the PACU would definitely improve efficiency but I guess they don't have the space to allocate for us.

RVU wise if they are outpatients you can bill a 99213 or 99214 outpatient code plus the ECT code, so you get around 3.8 - 4.4 RVUs per case, so nearly 8-9 per hour if treating two patients. If they are inpatient you can only bill the ECT code unless you are also the attending treating them that day which may not be the case.

Interestingly, though not surprisingly, I believe Medicare increased the facilty fee for ECT January 2025, but the RVU value remained the same. So hospital is getting paid more.

Do you attach both codes to the H&P for the procedure?