Relative Values for Physicians. Relative Value Studies, Inc.

Transcription

1 Relative Values for Physicians Relative Value tudies, Inc. 2012

2 Contents Contents...1 Introduction...1 User Guide... 1 Definitions of Terms in Relative Values for Physicians... 1 The Period... ervices With ignificant Direct Costs... Historical Background... Relative Value tudies Legal and Fair... 4 The Research Behind Relative Value... 4 Relative Values for Physicians with CPT s... 4 How to Use This Relative Value cale... Determining Fees... Conversion Factor Development... Productivity Measurement... 6 Cost and Profitability Analysis... 7 Capitation... 8 RVUs and the Capitation Contract... 8 Modifiers Anesthesia...17 Guidelines Calculations of Total Anesthesia Values urgery... Guidelines... Radiology...24 Guidelines Pathology and Laboratory Guidelines Medicine Guidelines Evaluation and Management Guidelines Category II s Guidelines Category III s Guidelines HCPC HCPC Disclaimer Level II (HCPC/National) Modifiers R Crosswalk Guidelines ervices with ignificant Direct Costs Conversion Factor Development Developing a Conversion Factor Gross Conversion Factor Worksheets Conversion Factors by Payer Conversion Factor Percentiles Procedural Index... 72

3 42 urgery 2012 Relative Values for Physicians Anes Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 0. cm or less excised diameter to cm excised diameter 1.1 to cm excised diameter 2.1 to.0 cm excised diameter.1 to 4.0 cm excised diameter over 4.0 cm Trimming of nondystrophic nails, any number Debridement of nail(s) by any method(s); 1 to or more 1170 Avulsion of nail plate, partial or complete, simple; single urgery each additional nail plate (List separately in addition to code for primary procedure) Evacuation of subungual hematoma 0 ZZZ 1170 Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal; with amputation of tuft of distal phalanx Biopsy of nail unit (eg, plate, bed, matrix, hyponychium, proximal and lateral nail folds) (separate procedure) Repair of nail bed Reconstruction of nail bed with graft Wedge excision of skin of nail fold (eg, for ingrown toenail) Excision of pilonidal cyst or sinus; simple extensive complicated Injection, intralesional; up to and including 7 lesions more than 7 lesions Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.0 sq cm or less to 20.0 sq cm each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure).0 0 ZZZ 1190 ubcutaneous injection of filling material (eg, collagen); 1 cc or less to.0 cc to 10.0 cc over 10.0 cc (I) Insertion of tissue expander(s) for other than breast, including subsequent expansion Replacement of tissue expander with permanent prosthesis + Add-on, Modifier 1 Exempt a Modifier 6 Exempt. Moderate edation # Resequenced

4 2012 Relative Values for Physicians Pathology and Laboratory Calcium; total ionized after calcium infusion test urine quantitative, timed specimen Calculus; qualitative analysis 80 quantitative analysis, chemical 8 infrared spectroscopy 8270 X-ray diffraction Carbohydrate deficient transferrin Carbon dioxide (bicarbonate) Path/Lab 827 Carboxyhemoglobin; quantitative qualitative Carcinoembryonic antigen (CEA) 8279 Carnitine (total and free), quantitative, each specimen Carotene 8282 Catecholamines; total urine m Reinstated s Revised l New M Deleted from CPT DC R RVI (I) Interim Value

5 2012 Relative Values for Physicians Evaluation and Management ection Evaluation and Management patient, which requires these key components: A problem focused history; A problem focused examination; traightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 10 minutes face-to-face with the patient and/or family patient, which requires these key components: An expanded problem focused history; An expanded problem focused examination; traightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 20 minutes face-to-face with the patient and/or family patient, which requires these key components: A detailed history; A detailed examination; Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 0 minutes face-to-face with the patient and/or family patient, which requires these key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 4 minutes face-to-face with the patient and/or family patient, which requires these key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 60 minutes face-to-face with the patient and/or family Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problem(s) are minimal. Typically, minutes are spent performing or supervising these services Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these key components: A problem focused history; A problem focused examination; traightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 10 minutes face-to-face with the patient and/or family. 6.0 E/M m Reinstated s Revised l New M Deleted from CPT DC R RVI (I) Interim Value