Customized Fee Analyzer. Fee information for your area. Sample page. Power up your coding optum360coding.com

Transcription

1 2019 Customized Fee Analyzer Fee information for your area Power up your coding optum360coding.com

2 Contents Introduction...1 Using the Analyzer...7 Analyzer Worksheets...13 Professional & Technical Splits of Global Services...23 Anesthesia Units, Follow-up Days, & Surgical Assistants...31 Fee Data Optum360, LLC

3 Using the Analyzer In the introduction, a number of applications were listed to illustrate ways that the Analyzer data might be used. In this section, some of these applications are described in more depth. However, before beginning this analysis and adjusting your fees, consider the following: 1. How will the new fees compare with what payers are willing to reimburse? 2. How will your patients react to a change in charges? 3. Do the new fees accurately reflect the cost and worth of your services? 4. Realize that you may be restricted in adjusting some fees by Preferred Provider Organization (PPO) and Health Maintenance Organization (HMO) contracts, as well as Medicare and workers compensation fee schedules. 5. Because fee ranges in the Analyzer are based on the first three digits or groups of the first three digits of ZIP codes, you need to assess where your locale stands in relation to others in this three-digit area. Initial Comparison of Current Fees to Fees Initially, you may want to compare a few of your most frequently reported services to get an idea of where your current fees fall when compared to others in your area. You can compare the data to all seven percentiles or, initially, you may want to select only two or three percentiles. Step One Select procedure codes for all types of services performed, including evaluation and management, surgery, radiology, laboratory, and medicine. Step Two Using a spreadsheet, list the following items in separate columns: Column 1 Column 2 Column 3 Columns 4 10 CPT code Current fee Medicare allowable Analyzer fees at the 50th, 60th, 75th, 0th, 5th, 90th, and 95th percentiles 201 Optum360, LLC

4 Page: 92 All CPT Codes / Multi-Specialty (AN) US Zip Codes CPT CodeMOD Sub Description BR Medicare Allowable 50th 2560 CLTX TRANS-SCAPHOPRILUNAR TYP FX DISLC W/MANJ ,139 1,163 1,255 1,20 1,349 1, OPEN TX TRANS-SCAPHOPERILUNAR FRACTURE DISLC ,156 2,201 2,376 2,423 2,553 2, CLOSED TX LUNATE DISLOCATION W/MANIPULATION ,302 1,329 1,434 1,463 1,541 1, OPEN TREATMENT LUNATE DISLOCATION ,953 1,993 2,152 2,194 2,312 2, ARTHRODESIS WRIST COMPLETE W/O BONE GRAFT ,523 2,574 2,779 2,34 2,96 3, ARTHRODESIS WRIST W/SLIDING GRAFT ,052 3,114 3,362 3,42 3,613 3, ARTHRODESIS WRIST W/ILIAC/OTHER AUTOGRAFT ,499 3,571 3,55 3,931 4,142 4, ARTHRODESIS WRIST LIMITED W/O BONE GRAFT ,929 2,99 3,227 3,291 3,46 3, ARTHRODESIS WRIST LIMITED W/AUTOGRAFT ,97 4,069 4,393 4,40 4,720 5, ARTHRD DSTL RAD/ULN JT SGMTL RESCJ ULNA W/WOBONE ,255 3,322 3,56 3,657 3,53 4, AMPUTATION FOREARM THROUGH RADIUS & ULNA ,441 2,491 2,690 2,743 2,90 3, AMP FOREARM THRU RADIUS&ULNA OPEN CIRCULAR ,116 2,159 2,331 2,377 2,505 2, AMP F/ARM THRU RADIUS&ULNA SEC CLOSURE/SCAR REVJ ,031 1,051 1,10 1, AMP FOREARM THRU RADIUS&ULNA RE-AMPUTATION ,441 2,491 2,690 2,743 2,90 3, KRUKENBERG PROCEDURE ,726 2,72 3,003 3,063 3,227 3, DISARTICULATION THROUGH WRIST ,441 2,491 2,690 2,743 2,90 3, DISARTICULATION THRU WRIST SEC CLOSURE/SCAR REVJ , DISARTICULATION THRU WRIST RE-AMPUTATION ,441 2,491 2,690 2,743 2,90 3, TRANSMETACARPAL AMPUTATION ,441 2,491 2,690 2,743 2,90 3, TRANSMETACARPAL AMPUTATION SEC CLOSURE/SCAR REVJ , TRANSMETACARPAL AMPUTATION RE-AMPUTATION ,441 2,491 2,690 2,743 2,90 3, UNLISTED PROCEDURE FOREARM/WRIST Y DRAINAGE FINGER ABSCESS SIMPLE DRAINAGE FINGER ABSCESS COMPLICATED DRAINAGE TENDON SHEATH DIGIT&/PALM EACH ,342 1,446 1,534 1,592 1,613 1, DRAINAGE OF PALMAR BURSA SINGLE BURSA ,342 1,446 1,534 1,592 1,613 1, DRAINAGE OF PALMAR BURSA MULTIPLE BURSA ,130 3,374 3,50 3,714 3,763 3, INCISION BONE CORTEX HAND/FINGER ,431 1,542 1,637 1,69 1,720 1, DECOMPRESSION FINGERS&/HAND INJECTION INJURY ,130 3,374 3,50 3,714 3,763 3, DECOMPRESSIVE FASCIOTOMY HAND ,342 1,446 1,534 1,592 1,613 1, FASCIOTOMY PALMAR PERCUTANEOUS ,012 1,074 1,114 1,129 1, FASCIOTOMY PALMAR OPEN PARTIAL ,342 1,446 1,534 1,592 1,613 1, TENDON SHEATH INCISION ,163 1,253 1,330 1,379 1,39 1, TENOTOMY PERCUTANEOUS SINGLE EACH DIGIT ARTHRT EXPL DRG/RMVL LOOSE/FB CARP/MTCRPL JT ,342 1,446 1,534 1,592 1,613 1, ARTHRT EXPL DRG/RMVL LOOSE/FB MTCARPHLNGL JT EA ,342 1,446 1,534 1,592 1,613 1, ARTHRT EXPL DRG/RMVL LOOSE/FB IPHAL JT EA ,073 1,157 1,22 1,273 1,290 1, ARTHROTOMY BIOPSY CARP/MTCRPL JOINT EACH ,060 1,125 1,167 1,13 1, ARTHROTOMY BIOPSY MTCARPHLNGL JOINT EACH ,02 1,109 1,176 1,220 1,236 1, ARTHROTOMY BIOPSY INTERPHALANGEAL JOINT EACH ,023 1,061 1,075 1, EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5CM/> ,15 1,277 1,355 1,406 1,424 1, EX TUM/VASC MAL SFT TIS HAND/FNGR SUBFSC 1.5CM/> ,11 1,952 2,071 2,149 2,177 2,209 Sample data 60th 75th 0th 5th 90th 95th 1,45 2,12 1,69 2,546 3,29 3,979 4,562 3,20 5,199 4,244 2,759 1,220 3,554 1,061 1, ,159 4,991 2,22 4,991 1,497 1, ,711 1,569 1,640 1,426 1,9 2, 201 Optum360, LLC

5 Page: 242 All CPT Codes / Multi-Specialty (AN) US Zip Codes CPT CodeMOD Sub Description BR Medicare Allowable 50th 745 TC VENOUS THROMBOSIS IMAGING VENOGRAM BILATERAL ,551 1,565 1,51 1,51 1, VENOUS THROMBOSIS IMAGING VENOGRAM BILATERAL G MYOCARDIAL IMAGING PET METABOLIC EVALUATION ,306 4,276 4,316 4,359 4,359 4, TC MYOCARDIAL IMAGING PET METABOLIC EVALUATION ,914 3,549 3,52 3,61 3,61 3, MYOCARDIAL IMAGING PET METABOLIC EVALUATION G MYOCARDIAL IMAGING INFARCT AVID PLANAR QUAL/QUAN ,592 1,607 1,623 1,623 1, TC MYOCARDIAL IMAGING INFARCT AVID PLANAR QUAL/QUAN ,210 1,221 1,233 1,233 1, MYOCARDIAL IMAGING INFARCT AVID PLANAR QUAL/QUAN G MYOCRD IMG INFARCT AVID PLNR EJEC FXJ 1ST PS TQ ,069 1,92 2,000 2,020 2,020 2, TC MYOCRD IMG INFARCT AVID PLNR EJEC FXJ 1ST PS TQ ,605 1,620 1,636 1,636 1, MYOCRD IMG INFARCT AVID PLNR EJEC FXJ 1ST PS TQ G MYOCRD INFARCT AVID PLNR TOMOG SPECT W/WO QUANTJ ,104 2,047 2,066 2,07 2,07 2, TC MYOCRD INFARCT AVID PLNR TOMOG SPECT W/WO QUANTJ ,65 1,674 1,690 1,690 1, MYOCRD INFARCT AVID PLNR TOMOG SPECT W/WO QUANTJ G CARD BLOOD POOL GATED PLANAR 1 STUDY REST/STRESS ,332 2,469 2,492 2,517 2,517 2, TC CARD BLOOD POOL GATED PLANAR 1 STUDY REST/STRESS ,039 1,926 1,944 1,963 1,963 1, CARD BLOOD POOL GATED PLANAR 1 STUDY REST/STRESS G CARD BL POOL GATED MLT STDY WAL MOTN EJECT FRACT ,06 3,34 3,70 3,90 3,90 3, TC CARD BL POOL GATED MLT STDY WAL MOTN EJECT FRACT ,592 2,952 2,90 3,009 3,009 3, CARD BL POOL GATED MLT STDY WAL MOTN EJECT FRACT G CARD BL POOL PLANAR 1 STDY WAL MOTN EJECT FRACT ,07 2,014 2,033 2,053 2,053 2, TC CARD BL POOL PLANAR 1 STDY WAL MOTN EJECT FRACT ,510 1,525 1,540 1,540 1, CARD BL POOL PLANAR 1 STDY WAL MOTN EJECT FRACT G CARD BL POOL PLNR MLT STDY WAL MOTN EJECT FRACT ,99 3,704 3,739 3,776 3,776 3, TC CARD BL POOL PLNR MLT STDY WAL MOTN EJECT FRACT ,459 2,704 2,730 2,757 2,757 2, CARD BL POOL PLNR MLT STDY WAL MOTN EJECT FRACT ,000 1,009 1,019 1,019 1, G MYOCRD IMAGE PET PERFUS SINGLE STUDY REST/STRESS ,33 4,334 4,375 4,41 4,41 4, TC MYOCRD IMAGE PET PERFUS SINGLE STUDY REST/STRESS ,964 3,640 3,675 3,711 3,711 3, MYOCRD IMAGE PET PERFUS SINGLE STUDY REST/STRESS G MYOCRD IMAGE PET PERFUS MULTPL STUDY REST/STRESS ,94 5,465 5,516 5,571 5,571 5, TC MYOCRD IMAGE PET PERFUS MULTPL STUDY REST/STRESS ,476 4,590 4,634 4,60 4,60 4, MYOCRD IMAGE PET PERFUS MULTPL STUDY REST/STRESS G CARD BL POOL GATED SPECT REST WAL MOTN EJCT FRCT ,753 3,249 3,20 3,312 3,312 3, TC CARD BL POOL GATED SPECT REST WAL MOTN EJCT FRCT ,332 2,469 2,493 2,517 2,517 2, CARD BL POOL GATED SPECT REST WAL MOTN EJCT FRCT G CARD BL POOL GATED 1 STDY REST RT VENT EJCT FRCT ,170 1,11 1,192 1,192 1, TC CARD BL POOL GATED 1 STDY REST RT VENT EJCT FRCT CARD BL POOL GATED 1 STDY REST RT VENT EJCT FRCT UNLISTED CARDIOVASCULAR PX DX NUCLEAR MEDICINE Y G N PULMONARY VENTILATION IMAGING TC N PULMONARY VENTILATION IMAGING N PULMONARY VENTILATION IMAGING Sample data 60th 75th 0th 5th 90th 95th 1, ,374 3, ,629 1, ,027 1, ,094 1, ,526 1, ,922 3, ,061 1, ,79 2,766 1,023 4,434 3, ,590 4, ,324 2, , Optum360, LLC