Kypho vs intracept -HOPD

[bedrock]

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For you hospital employed docs.

How does the RVU payment per time spent, compare between doing intracept or a Kyphoplasty case?

 

[so55b]

Similar to me

 

[bedrock]

Similar to me

Thank you.

Can some of the other HOPD docs please comment as well?

 

[SgtThunderfistMD]

I make more RVU's doing office visits per minute than intracept/kypho per minute. I punt those to others.

 

[mille125]

I make more RVU's doing office visits per minute than intracept/kypho per minute. I punt those to others.

sad but true.......

 

[BoardingDoc]

I make more RVU's doing office visits per minute than intracept/kypho per minute. I punt those to others.

During fellowship I realized that the most efficient procedure by far in terms of wRVU/minute is signing a prescription. This doesn't hold true in PP, but I quickly understood why some people were ok doing COT in a HOPD setting and simply sitting around collecting their 99214 pellets.

 

[BobBarker]

everyone gets paid the same wrvu for codes with a wrvu value. You can find the exact numbers easily in the intracept coding and kyphon coding guides. Both of these are in the same tier at 7 to 7.5 and 50% of that for the 2nd level in general.

 

[SpineandWine]

I disagree. Take care of your patient, don’t punt unless you can’t take care of them
Not much difference between 15 M net worth and 10 M net worth at end of career (or even 25 M)

 

[Orin]

Splitting hairs but BVNA is faster for me but I am stubborn and like bipedicular access for kyphos

 

[bedrock]

Splitting hairs but BVNA is faster for me but I am stubborn and like bipedicular access for kyphos

everyone gets paid the same wrvu for codes with a wrvu value. You can find the exact numbers easily in the intracept coding and kyphon coding guides. Both of these are in the same tier at 7 to 7.5 and 50% of that for the 2nd level in general.

Thanks.
Other than Orin, I expect most of us could do a Kyphoplasty case in 1/2 or 2/3 the time of a typical 3 nerve intracept case, particularly with extra anesthesia turnover time needed for intracept.

There is a semi local hopd doc that does both procedures. I’m a full partner in an ortho group with our own ASC. (And a procedure room for kypho)

I was debating on asking this HOPD doc to send me some kypho if I send him some intracept but it seems they would not consider that a fair trade?

 

[BobBarker]

No, you can’t ask that. You could see if there is some unmet need in his practice (regen/hospital quit taking Humana/etc) that you can assist with and send him Medicare intracept if you no longer want those.

 

[Ferrismonk]

I'm pretty sure that Intracept is not allowed in a HOPD. You need an OR.

 

[bedrock]

I'm pretty sure that Intracept is not allowed in a HOPD. You need an OR.

Sorry. I mis typed. This doc is employed by a hospital and does all of his kypho and intracept cases in an OR.

I do intracept under geta in our ASC, and kypho with po (sometimes IV) sedation in our procedure room.

 

[bedrock]

No, you can’t ask that. You could see if there is some unmet need in his practice (regen/hospital quit taking Humana/etc) that you can assist with and send him Medicare intracept if you no longer want those.

I’m already sending him Medicare intracept for a year. He is happy to do them.

I was just wondering if he also gets paid more for kypho vs intracept , per time spent.

unless intracept pays proportionally better in a hospital vs pp , he won’t want to send me kypho cases.

 

[BobBarker]

No, he can’t. It doesn’t make financial sense for him but also goes against the overall mission of him to generate facility fees for the hospital.

 

[Ronin1]

I'm pretty sure that Intracept is not allowed in a HOPD. You need an OR.

I do it all the time in my HOPD procedure room. It depends on how the site of service is billed. Local and IV sedation

 

[1 Up]

I'm pretty sure that Intracept is not allowed in a HOPD. You need an OR.

I do Intracept in the HOPD procedure room setting with nurse sedation.

On to the OPs question:

For Intracept, assuming you're doing 2 levels, you're fast, then it's somewhat comparable to kypho, but for me kypho is still better by about 1 RVU per hour if you only do one level. If you're doing Intracept in the OR, under GETA, the anesthesia time, and room turnover time, makes the RVU per hour garbage for this procedure.

Now, if you do a 2 level kypho, and you're pretty quick, then kypho is FAR better than Intracept, no matter how fast you are.

 

[Centurion38]

Sorry. I mis typed. This doc is employed by a hospital and does all of his kypho and intracept cases in an OR.

I do intracept under geta in our ASC, and kypho with po (sometimes IV) sedation in our procedure room.

You need to do Intracept under MAC. Very rarely is GETA needed. GETA is a huge time suck, even in ASC.

Intracept, per WRVU, is the worst surgical procedure I do in terms of time spent (excepting IT pumps).

I'm also fast and efficient, and have done more cases than anyone in the state.

If you hit hard bone and are doing 3-4 levels, you might as well set a trash can full of money on fire in the OR and enjoy the aroma while you and the rep debate accessing the other pedicle after you sheared off the tip of the J in some 45 year old Neanderthal's S1.

 

[BobBarker]

Yes, MAC for intracept. I have never had a problem.

 

[bedrock]

Yes, MAC for intracept. I have never had a problem.

Does anesthesia get paid more for general? Anesthesia is the one pushing for general

 

[CleanUp]

Does anesthesia get paid more for general? Anesthesia is the one pushing for general

No we don’t. It’s just easier to secure the airway and “forget about it”. MAC takes a finer approach and maintenance IMHO.