Relative Values for Physicians Relative Value tudies, Inc. 2012
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... 10 Anesthesia...17 Guidelines... 17 Calculations of Total Anesthesia Values... 24 urgery... Guidelines... Radiology...24 Guidelines... 24 Pathology and Laboratory... 29 Guidelines... 29 Medicine... 89 Guidelines... 89 Evaluation and Management... 441 Guidelines... 441 Category II s... 46 Guidelines... 46 Category III s... 487 Guidelines... 487 HCPC... 499 HCPC Disclaimer... 499 Level II (HCPC/National) Modifiers... 499 R Crosswalk... 70 Guidelines... 70 ervices with ignificant Direct Costs... 70 Conversion Factor Development... 71 Developing a Conversion Factor... 71 Gross Conversion Factor Worksheets... 714 Conversion Factors by Payer... 720 Conversion Factor Percentiles... 722 Procedural Index... 72
42 urgery 2012 Relative Values for Physicians Anes 11640 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 0. cm or less 2.7 11641 excised diameter to cm.7 11642 excised diameter 1.1 to cm 4.7 1164 excised diameter 2.1 to.0 cm.7 11644 excised diameter.1 to 4.0 cm 6.7 11646 excised diameter over 4.0 cm 7.7 11719 Trimming of nondystrophic nails, any number 0. 11720 Debridement of nail(s) by any method(s); 1 to 0. 11721 6 or more 1170 Avulsion of nail plate, partial or complete, simple; single urgery + 1172 11740 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;. 1172 with amputation of tuft of distal phalanx 4.9 117 Biopsy of nail unit (eg, plate, bed, matrix, hyponychium, proximal and lateral nail folds) (separate procedure) 1.8 11760 Repair of nail bed.2 11762 Reconstruction of nail bed with graft 4.7 1176 Wedge excision of skin of nail fold (eg, for ingrown toenail) 11770 Excision of pilonidal cyst or sinus; simple 11771 extensive 7.2 11772 complicated 8.8 119 Injection, intralesional; up to and including 7 lesions 0. 11901 more than 7 lesions 11920 Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.0 sq cm or less. 11921 6.1 to 20.0 sq cm 7.0 + 11922 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 1191 1.1 to.0 cc 1192.1 to 10.0 cc.6 1194 over 10.0 cc (I) 11960 Insertion of tissue expander(s) for other than breast, including subsequent expansion 1. 11970 Replacement of tissue expander with permanent prosthesis + Add-on, Modifier 1 Exempt a Modifier 6 Exempt. Moderate edation # Resequenced
2012 Relative Values for Physicians Pathology and Laboratory 17 8210 Calcium; total 0. 820 ionized.4 2.4 821 after calcium infusion test 1. 0.4 8240 urine quantitative, timed specimen 1.2 0.4 82 Calculus; qualitative analysis 80 quantitative analysis, chemical 8 infrared spectroscopy 8270 X-ray diffraction 2.1 827 8274 Carbohydrate deficient transferrin Carbon dioxide (bicarbonate) 1. 0. 0. Path/Lab 827 Carboxyhemoglobin; quantitative.1 2.2 8276 qualitative 0. 8278 Carcinoembryonic antigen (CEA) 8279 Carnitine (total and free), quantitative, each specimen. 1.2 2. 8280 Carotene 8282 Catecholamines; total urine. 1.1 2.4 m Reinstated s Revised l New M Deleted from CPT DC R RVI (I) Interim Value
2012 Relative Values for Physicians Evaluation and Management ection Evaluation and Management 447 99201 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. 6. 99202 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. 9. 9920 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. 14.0 99204 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. 20.0 9920 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..0 99211 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.. 99212 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