RVU question
Started by PMG03470
First of all you don't use modifiers if you get paid on RVUs you are hospital employed and the coder does this....but it depends on your contract. Some people get 100 percent of all procedures. Most get 50 percent of each additional procedure. Better than the 25 in PP
Thanks, no I don’t put in my own modifiers. I was asking theoretically since it will be billed with modifiers how this changes the total RVUs. This is my first hospital employed job and I have only been here one month. I’m keeping an excel sheet of my cpt/RVUs so I can compare to my monthly report to make sure I’m getting what I billed. Just not sure how to take into consideration multiple procedures.
In PP ortho/pod/msg/solo whatever, you get 50% of insurance contracted rates on all procedures but the first unless denied if you're owner (so put top RVU proc first line)... but they're facility RVUs, not wRVU. You get paid on what you collect per contract if non-owner.
For hospital employ (wRVU), you don't needs mods, you don't get reduction generally, you don't have to worry if the stuff gets paid. Hospital billing is not really real world... they just want you to generate OR time, diag tests, labs, etc (surgeon fee is nice but very small in grand scheme for them).
Proc you describe would be 12 wRVU for 28114 pan met + 8.6 wRVU for 28750 great toe fusion. You could do splint or cast codes if appropriate.
In collections setup, it'd be 25.6 facility RVU + 17 fac RVU (2nd one gets 50%) for same codes... but what gets paid is what matters (RVU don't really matter aside from helping decide which code is first line). You'd also probably do e/m, L4361 boot, otc stuff, etc in office pre op.
For hospital employ (wRVU), you don't needs mods, you don't get reduction generally, you don't have to worry if the stuff gets paid. Hospital billing is not really real world... they just want you to generate OR time, diag tests, labs, etc (surgeon fee is nice but very small in grand scheme for them).
Proc you describe would be 12 wRVU for 28114 pan met + 8.6 wRVU for 28750 great toe fusion. You could do splint or cast codes if appropriate.
In collections setup, it'd be 25.6 facility RVU + 17 fac RVU (2nd one gets 50%) for same codes... but what gets paid is what matters (RVU don't really matter aside from helping decide which code is first line). You'd also probably do e/m, L4361 boot, otc stuff, etc in office pre op.
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This. It's night and day difference compared to private practice.
When I asked my case logs for boards the person sent me their billing that's associated with the all the surgeries I did. I attached it here. Now this is just for an I&D case. Everything gets billed under the surgery. Radiology, PT, even COVID test. The hospital bundles all this and then get the reimbursement. They don't really have to fight each CPT like we do in the private world. Implants get 300% markups.
Holy cow. Didn't know this.
Just remember this. Nobody carries how much you get paid more than you do. 100% you should be reviewing everything.
