Thoughts on 2013 CMS payment rates

[emd123]

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In-office rates


Major joint injection down 13%
-now pays less than intermediate (WTF?)

CESI and LESI up 1-2% (okay, better than down 1-2%)

Greater occipital up 6%

Intercostal mult down 10% 👎

Lumbar TF down 3% for 1st and 9% for add on (ouch!)

Facets: even or down 1%

RFs: down 8-9% (ouch! Ouch!)

Fluoro 77003 up 47% (small victory?)




Thoughts?

 

[stim4u]

We are targets. try to carve-out your contracts with independent/commercial insurance carriers. Make your reinburesement them less dependent on yearly medicare fluctuations. This is hard to do, and I have 3-4 carriers that do this for our practice, the majority of health cariers including blue cross and united/oxford will follow suit and reduce commercial insurance payment reductions. In the end, less access to medicare patients in my practice. Also, what is the point of working hard with a 40% tax rate, local taxes at 6-10%, 1% additional obama tax rate, dividend at 20%, payroll tax increases, it goes on and on. An the dems want more revenue.... Good luck in 2013.

 

[bedrock]

BTW, my data shows that RF and ILESI are down much more than you stated. Where did you get your info?

 

[emd123]

Thanks for the summary. How did you get your information?



Did you notice that fluoro 77002(outside of spine) was down by 25%!!!

Also the ultrasound guidance code 76942 was down by 25%!!!!

Between the 20610 major joint reduction and the ultrasound cut, they're really attacking all the docs that have been injecting every peripheral structure under ultrasound.



BTW, my data shows that RF and ILESI are down much more than you stated. Where did you get your info?

I was referencing the in-office column listed on the ASIPP.org "fee schedule" link here:

http://www.asipp.org/documents/Physcians2013Final.pdf

 

[bedrock]

I was referencing the in-office column listed on the ASIPP.org "fee schedule" link here:

http://www.asipp.org/documents/Physcians2013Final.pdf

Thanks,

That looks more accurate that my source, which I believe was still included the anticipated annual 30% CMS cut.


BTW- $8,000 for in-office kyphoplasty? Damn......, time to start doing those in-office.

 

[Doctodd]

What victory for 77003? The code is bundled so they don't pay it!!!

 

[SSdoc33]

What victory for 77003? The code is bundled so they don't pay it!!!

exactly. i can only think of a few times where you can actually use it. ganglion impar. sympathetic blocks, stellate. maybe a pars defect injection. anything else?

 

[emd123]

exactly. I can only think of a few times where you can actually use it. Ganglion impar. Sympathetic blocks, stellate. Maybe a pars defect injection. Anything else?

il esi
62310 & 62311

 

[SSdoc33]

il esi
62310 & 62311

oh, thats right. i do so few lumbar interlaminars, i guess i forgot. cervical interlaminars are also billable

 

[emd123]

Thanks,

That looks more accurate that my source, which I believe was still included the anticipated annual 30% CMS cut.


BTW- $8,000 for in-office kyphoplasty? Damn......, time to start doing those in-office.

Yep, $8000 and $4000 for add on level. That's the only thing they pay for anymore. Working on getting set up to do them in-office as we speak.

 

[voltron]

we do kyphos in office...its sort of a pain with the constant AP to lateral imaging but if your tech is good then its still pretty quick.

 

[jonnylingo]

I know this isn't EMG forum, but since we're on the subject...

In 2013 I get 1.25 RVU for a typical single limb NCS. Throw in .92 RVU for the single limb EMG, and I haven't even made as much as a 99204.

 

[powermd]

we do kyphos in office...its sort of a pain with the constant AP to lateral imaging but if your tech is good then its still pretty quick.

Who's balloons do you use? How much and what are you using for sedation? How do you recover the patient (stretchers, exam table in an office, in suite, etc)?

We're looking at making the transition, but I see the sedation issue as a potential hiccough. My last kypho got 850 mg of prop in the OR. Way more snowed than need be, but still.

 

[lobelsteve]

Who's balloons do you use? How much and what are you using for sedation? How do you recover the patient (stretchers, exam table in an office, in suite, etc)?

We're looking at making the transition, but I see the sedation issue as a potential hiccough. My last kypho got 850 mg of prop in the OR. Way more snowed than need be, but still.

You're nuts. I do 1/3 with local only. The rest get 2 and 2 and are done without hurting.

SML.

 

[Doctodd]

Propofol is easy to work with in healthy patients....which most kypho patients might not fit exactly. Just keep them on pulseox and the O2 in perfect working order with an extra O2 tank just in case.

 

[powermd]

Uhh.. I was busy doing the kyphoplasty. The OR CRNA was busy snowing the guy with prop. In the PACU I asked the nurse what he got since he was still not yet awake 10 minutes after leaving the room.

I was just curious what is the minimum level of sedation you can get away with to hammer away at someone's spine and inflate balloons in their vertebrae. Sounds like I have my answer. Office kypho here I come!

You're nuts. I do 1/3 with local only. The rest get 2 and 2 and are done without hurting.

SML.

 

[Jcm800]

Uhh.. I was busy doing the kyphoplasty. The OR CRNA was busy snowing the guy with prop. In the PACU I asked the nurse what he got since he was still not yet awake 10 minutes after leaving the room.

I was just curious what is the minimum level of sedation you can get away with to hammer away at someone's spine and inflate balloons in their vertebrae. Sounds like I have my answer. Office kypho here I come!

I have done plenty with local, plenty with I've sedation, but still none in the office...I just worry about them going south in my office...

 

[voltron]

Either stryker or medtronic...both seem to work well so I can't really say I pefer one. Usually just whichever rep is available. As far as sedation usually 4 mg versed, 1000 mcg alfentanyl, and usually about 40-80mg propofol in 10 mg boluses here and there. Its not that painful except when the balloon goes up so we give a bit of prop before that. We usually schedule them at 9am, they then stay 2 hrs post procedure in our recovery area. Staff does neuro checks every 30 minutes until they leave. I guess if u think someones going be tough imaging wise or require a lot of sedation then I would just do it at the hospital. Usually its the chip shots we like doing at the office, the skinny people with the lumbar/lower thoracic fractures. Its a nice change of pace and primaries like it since most places around here make u admit the patient overnight after a kypho. The 8k isn't bad either!

 

[jsaul]

Either stryker or medtronic...both seem to work well so I can't really say I pefer one. Usually just whichever rep is available. As far as sedation usually 4 mg versed, 1000 mcg alfentanyl, and usually about 40-80mg propofol in 10 mg boluses here and there. Its not that painful except when the balloon goes up so we give a bit of prop before that. We usually schedule them at 9am, they then stay 2 hrs post procedure in our recovery area. Staff does neuro checks every 30 minutes until they leave. I guess if u think someones going be tough imaging wise or require a lot of sedation then I would just do it at the hospital. Usually its the chip shots we like doing at the office, the skinny people with the lumbar/lower thoracic fractures. Its a nice change of pace and primaries like it since most places around here make u admit the patient overnight after a kypho. The 8k isn't bad either!

that is fraud.hospitals got busted for that

 

[LordArius]

We use DFine at our faciliity. Cost is less and you can do multiple levels due to longer working time with cement. Also, you can do RF ablation of vertebral tumors which is separately billable.

 

[onewithpain]

I was referencing the in-office column listed on the ASIPP.org "fee schedule" link here:

http://www.asipp.org/documents/Physcians2013Final.pdf

Does medicare actually pay the rest of you the amounts listed on the asipp document? When I audit my books I see #s that are close but not quite. A quick review showed slightly lower reimbursement for most procedures, but higher for second levels, and not consistent from patient to patient.