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Greedy Bastard Question...

Discussion in 'Emergency Medicine' started by SCER2005, Mar 6, 2007.

  1. SCER2005

    SCER2005 Junior Member
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    Ok, I have a question regarding RVU's. I'm still in residency, but the "real world" is looming ever closer. I keep hearing people talk about "X procedure reimburses really well". This has been for things like hip reduction, fecal disimpactions, dental blocks... Is there a list of this stuff somewhere??? or is this just something learned through experience???

    I ask because, while I am not greedy enough to just run a bill up on a patient for the hell of it. However, if it's something the patient will benefit from and I can get amply reimbursed for, why not? Example of what I mean: patient with a tooth ache with no signs of infection who just really needs to see there dentist. I could tell them to take NSAIDs (or if I'm really generous maybe 2-3 narc pills) OR I could block the tooth and substantially increase my compensation. Thanks for the input.
     
  2. jmcelv

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    Money greed can cost you if you don't control your hunger...I read your post and say to myself, NSAIDs for tooth pain " what if the patient has ESRD" or Narcs for pain as well " what if the pain has opoid allergy" ...money can blind rational judgement. Coming from a pharmacist who is entering Dental School, do not let money become that main factor that dictates your life. I am giving up a salary that pays $50/hr at 60 hours/week "you do the math monthly" because money isn't everything although it supports life and we all need it to survive. If you really focus on patient care and understand the principles of marketing than skys the limit
     
  3. margaritaboy

    margaritaboy Senior Member
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    :confused: :confused:
     
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  4. bulgethetwine

    bulgethetwine Membership Revoked
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    What the hell was this?? Too much nitric at dental school today????

    Back to the original poster's question:

    Nice question, I'd like to know, too. It shouldn't at all be misconstrued as a greed-seeking question. In fact, I think it is appropriately relevant to the current climate of "cost justification" at every turn.
     
  5. wadoc

    wadoc Resident
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    ...to go to school for 4 years to make huge amounts of money working 3.5 days a week. But driving the porsche and frequent golfing will be tough!
     
  6. NinerNiner999

    NinerNiner999 Senior Member
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    Ha ha ha. HA HA HA. HAHAHAHAHAHA :laugh: :laugh: :laugh:

    Sorry - couldn't resist. That's a pretty funny quote. HA HA.
     
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  7. nocallaochicas

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    I double your :confused: :confused: and raise a WTF

    I too would like to see such a list...I am nowhere near practicing and will unlikely ever be in the community enough for it to matter, but it seems weird to me that I know nothing about how much EM docs (which I will be someday if all goes well on match day) get paid for stuff. Someone said something like 6000 dollars for a chest tube above - and I am so uninformed that I couldn't tell you if that was sarcasm or not.

    So, if anyone else has such a list, please inform us.

    thanks,
    ncc
     
  8. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner
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    I bet if Medicare actually allowed the list to be seen with unclean eyes then they would have to change it later that day. Because, as we all know, if we knew what to bill for, then all of us would actually do it.
     
  9. EctopicFetus

    EctopicFetus Keeping it funky enough
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    This list isnt quite so simple. It varies based on who your patients are, who does the procedure etc. A lac repaired by a plastics guy gets reimbursed more than one repaired by an ED doc even if the lac is the exact same. This varies by region.

    Also, one of my attendings told me that thrombosed hemorrhoid removal pays quite well.
     
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  10. EMRaiden

    EMRaiden Senior Member
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    The the # of RVU's is the same for all providers and is determined by the procedure (and documentation), so I don't see why one specialty would get more $$ for the same # of RVUs.

    ACEP puts on a coding and documentation course, look at www.acep.org.
     
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  11. fenixwbp

    fenixwbp Junior Member
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    Hold on. I thought most EP's were paid by the hour. I know some programs are "eat what you catch", but if you're recieving an hourly salary why does it matter how much the procedures you perform actually cost? Doesn't that money just go to the hospital, and an EP's salary is independent of these numbers?
     
  12. USCDiver

    USCDiver Percocet-R-US
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    If your group is making substantially more money by doing procedures and appropriately documenting them for billing, your hourly rate will increase. The phase is 'eat what you kill', by the by.
     
  13. Blue Dog

    Blue Dog Fides et ratio.
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    Correct re: "Eat what you kill."

    Directly or indirectly, the amount of money you will make in EM will depend upon reimbursement, even if you're shielded from all the gory details by professional coders and a salary.
     
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  14. BADMD

    Physician 10+ Year Member

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    While many EP get paid hourly, many groups also have RVU targets and RVU bonuses. While you might get paid the same as the guy working next to you, if you bill smarter (higher level per patient) or do more proceudures (additional billing), you may get a bigger bonus (depending on contract) or you might not get fired for underproducing.
     
  15. EctopicFetus

    EctopicFetus Keeping it funky enough
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    Right I believe RVUs are standardized but the code (or amount paid per RVU) might depend on other factors. I could be wrong but attendings I work with have told me that specialists make more doing things other non-specialists do.
     
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  16. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner
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    Yeah, the RVU is different per specialty. Hence, Plastics bill more for lacs. Derm can bill more for a skin biopsy than FM. Gastro gets more for a scope. You get the idea.

    It's really dumb, and further promulgates the specialty phenomenon.
     
  17. skowly

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    how much suturing do EPs really do?
     
  18. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner
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    Surely you're joking.

    Here's an answer. A lot. Where do people go when they need stitches?
     
  19. skowly

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    not joking, just stupid :-/
     
  20. Dr. Wexler

    Dr. Wexler Member
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    That's interesting considering that anyone doing a procedure must be able to meet the standard of care. For example, FP's who do scopes aren't held to a lower standard are they? (Which I think is ridiculous, but that's another discussion entirely.)
     
  21. ERMudPhud

    ERMudPhud Back for a visit
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    To answer to OP, go here

    https://catalog.ama-assn.org/Catalog/cpt/cpt_search.jsp

    Reimbursement varies regionally and is higher for private insurance but as for our previous discussions

    intubation $125

    Chest tube $250

    Central line $250 ( I think, there were a lot of versions of this so I might have picked the wrong one)

    Fecal disimpaction $280 (Although if I read it right it only counts if done under sedation)
     
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  22. Dakota

    Dakota Senior Member
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    My plan is to invent nanites that will do this job for me, they'd be like little tiny miners.
     
  23. The White Coat Investor

    The White Coat Investor Practicing Doc and Blogger
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    Final Medicare 2007 Reimbursement:

    CMS
    Payment
    99281 0.51 $ 19.33 (Suture removal etc)
    99282 0.98 $ 37.14
    99283 1.60 $ 60.64 (URI)
    99284 2.91 $110.28 (Pyelonephritis etc)
    99285 4.36 $165.23 (Admitted chest pain patient)
    99291 5.51 $208.82 (At least 30 minutes critical care time spent with patient)

    an LP pays $65

    suturing < 2.5 cm = $95, 2.5 cm-7.5 cm= $106.28, 7.5 cm-12.5 cm $125.48, 12.5-20 $157, 20-30cm $200, >30 cm $230, You get a few bucks more if it is on the face, ears, lips, nose, or mucous membranes

    Removal of a corneal foreign body (using a slit lamp) $50

    Abscess I&D $80
     
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  24. GeneralVeers

    GeneralVeers Globus Hystericus
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    Wow, the reimbursement for large lacerations is low!

    It's almost not worth suturing that 10-20 cm lac, considering the other billable patients you could see during that time.

    I hear that you get additional billing for undermining the lac. , and documenting it. Is this the case?
     
  25. NinerNiner999

    NinerNiner999 Senior Member
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    It is true, complex lacs with multiple layer closure and trimming (dog-ears) can be billed for more. As you say, though, those long lacs aren't very cost-effective, unless it is a slow night and there aren't sicker patients beating down your doors.

    Usually, if the lac is that big, I suggest to the patient that a plastic surgeon could make it look much better than I could (;) ) and most of the time they request for me to call one. Then, I can call the plastic surgeon and politely say that the patient is requesting their skills. This has not failed yet. Besides - the larger the lac, the more complications can arise, and these patients may be better off in plastics clinic anyway...

    Oh, and don't forget, you can also bill around $35 for physician venipuncture. Keep track of all of those EJ's...
     
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  26. primadonna22274

    primadonna22274 Senior Member
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    This is probably why our attendings designate all the lacs to we PAs.
    But damn, my facial lacs have been looking good....
    :D

     

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