SAMPLE. Relative Values for Physicians. Relative values based on physician survey data from Relative Value Studies, Inc. ICD-10.

Transcription

1 Relative Value for Phyician Relative value baed on phyician urvey data from Relative Value tudie, Inc. AMPLE 2017 a ICD-10 A full uite of reource including the latet code et, mapping product, and expert training to help you make mooth tranition.

2 Content Introduction...1 Uer Guide... 1 Definition of Term in Relative Value for Phyician... 1 The Global Period... 3 ervice With ignificant Direct Cot... 3 Hitorical Background... 3 Relative Value tudie Legal and Fair... 4 The Reearch Behind Relative Value Unit... 4 Relative Value for Phyician with CPT Code... 4 How to Ue Thi Relative Value cale... 5 Determining Fee... 5 Converion Factor Development... 5 Productivity Meaurement... Cot and Profitability Analyi... 7 Capitation... 8 RVU and the Capitation Contract... 8 Modifier Anetheia... Guideline... Calculation of Total Anetheia Value Anetheia ection urgery...33 Guideline urgery ection Radiology Guideline Radiology ection Pathology and Laboratory Guideline Pathology and Laboratory ection Medicine Guideline Medicine ection Evaluation and Management Guideline Evaluation and Management ection Category II Code Guideline Category II ection Category III Code Guideline Category III ection... 5 HCPC HCPC Diclaimer Level II (HCPC/National) Modifier HCPC ection R Code Crowalk Guideline ervice with ignificant Direct Cot AMPLE Converion Factor Development Developing a Converion Factor Gro Converion Factor Workheet Converion Factor by Payer... 7 Converion Factor Percentile Procedural Index Optum30, LLC

3 Introduction Introduction Uer Guide It long hitory and careful development make Relative Value for Phyician the mot accurate and comprehenive relative value ytem available. Ue of Relative Value for Phyician pan North America and everal European countrie. In thi relative value ytem, value are provided for phyician ervice contained in the American Medical Aociation (AMA) Phyician Current Procedural Terminology (CPT ) ytem, a well a Medicare HCPC Level II (National) code. Additional code, a recommended by phyician, have been Definition of Term in Relative Value for Phyician Column Decription (1) UPD Thi column indicate the date the procedure wa updated for Relative Value for Phyician. For the year 201 the update tamp will read 10; for 20, 0; etc. Mid-year update are poted to the web ite during the preceding year. The update tamp 1 would indicate a value that wa changed mid-year 20. The update tamp i removed after three year. (2) TYPE Indicate code type or AMA icon M Indicate a code that ha been deleted from the CPT book or HCPC code et. The CPT copyright remain with the AMA. Thi publication contain thoe code which have been deleted within the pat year for CPT code and HCPC code. One year of deleted code i maintained for both CPT and HCPC code. included in thi ytem and aigned relative value to addre pecial reimburement iue. Relative Value for Phyician provide a uer-friendly liting of phyician ervice with unit value. The accompanying intruction, guideline, and modifier explain the application and ue of relative value unit in the medical practice. All ection of the book may be ued by any or all phyician or other qualified health care profeional. For example, code found in the urgical ection are not confined to ue by a urgeon. Likewie, code found in the medicine ection are not limited to ue by internit or primary care provider. (1) (2) (3) (4) (5) () (7) UPD Code Decription Unit Ane Global 0 K 130 Image-guided fluid collection drainage by catheter (eg, abce, hematoma, eroma, lymphocele, cyt), oft tiue (eg, extremity, abdominal wall, neck), percutaneou l The triangle indicate a change in the code decription. The circle indicate that the code wa added to the CPT book or HCPC code et. : The plu indicate an add-on code. Add-on code decribe additional intra-ervice work aociated with the primary procedure. They are performed by the ame phyician on the ame date of ervice a the primary ervice/procedure, and mut never be reported a a tand-alone code. AMPLE * Indicate the procedure i modifier 51 exempt. Code identified a exempt from modifier 51 are not ubject to multiple procedure rule. No reimburement reduction or modifier 51 i applied. B K 3.7 (I) 3 Code identified by thi Optum30 icon indicate that the procedure hould not be reported with modifier 51 (multiple procedure). Any code with thi icon i backed by official AMA guideline but i not identified by the AMA with their modifier 51 exempt icon. Indicate the procedure include moderate edation a an inherent part of the ervice. Becaue thee ervice include moderate edation, the provider performing the diagnotic or therapeutic ervice that the edation upport hould not report moderate edation code in addition to the baic procedure code. In rare intance a econd provider other than the provider performing the diagnotic or therapeutic 201 Optum30, LLC CPT 201 American Medical Aociation. All Right Reerved.

4 201 Relative Value for Phyician urgery 145 UPD Code Decription Unit Ane Global 3833 with thrombectomy, autogenou or nonautogenou dialyi graft (eparate procedure) Inertion of Thoma hunt (eparate procedure) Dital revacularization and interval ligation (DRIL), upper extremity hemodialyi acce (teal yndrome) 11. (I) 380 External cannula declotting (eparate procedure); without balloon catheter 381 with balloon catheter Thrombectomy, percutaneou, arteriovenou fitula, autogenou or nonautogenou graft (include mechanical thrombu extraction and intra-graft thrombolyi) Venou anatomoi, open; portocaval renoportal caval-meenteric plenorenal, proximal plenorenal, dital (elective decompreion of eophagogatric varice, any technique) Inertion of tranvenou intrahepatic portoytemic hunt() (TIP) (include venou acce, hepatic and portal vein catheterization, portography with hemodynamic evaluation, intrahepatic tract formation/dilatation, tent placement and all aociated imaging guidance and documentation) Reviion of tranvenou intrahepatic portoytemic hunt() (TIP) (include venou acce, hepatic and portal vein catheterization, portography with hemodynamic evaluation, intrahepatic tract recanulization/dilatation, tent placement and all aociated imaging guidance and documentation) Primary percutaneou tranluminal mechanical thrombectomy, noncoronary, non-intracranial, arterial or arterial bypa graft, including fluorocopic guidance and intraprocedural pharmacological thrombolytic injection(); initial veel AMPLE econd and all ubequent veel() within the ame vacular family (Lit eparately in addition to code for primary mechanical thrombectomy procedure) econdary percutaneou tranluminal thrombectomy (eg, nonprimary mechanical, nare baket, uction technique), noncoronary, non-intracranial, arterial or arterial bypa graft, including fluorocopic guidance and intraprocedural pharmacological thrombolytic injection, provided in conjunction with another percutaneou intervention other than primary mechanical thrombectomy (Lit eparately in addition to code for primary procedure) (I).2 (I) (I) 5.0 (I) ZZZ ZZZ urgery Percutaneou tranluminal mechanical thrombectomy, vein(), including intraprocedural pharmacological thrombolytic injection and fluorocopic guidance Percutaneou tranluminal mechanical thrombectomy, vein(), including intraprocedural pharmacological thrombolytic injection and fluorocopic guidance, repeat treatment on ubequent day during coure of thrombolytic therapy.1 m Reintated Code Revied Code l New Code M Deleted from CPT DC Code R RVI Code (I) Interim Value Note: For a complete explanation of each icon, pleae ee the Introduction 201 Optum30, LLC CPT 201 American Medical Aociation. All Right Reerved.

5 3 Pathology and Laboratory 201 Relative Value for Phyician UPD Code Decription Unit Global 10 l 881 Obtetric panel (include HIV teting) 800 Amikacin Caffeine Path/Lab Carbamazepine; total free Cycloporine Clozapine Digoxin; total free Valproic acid (dipropylacetic acid); total Valproic acid (dipropylacetic acid); free Ethouximide Everolimu AMPLE Gentamicin Gabapentin, whole blood, erum, or plama Haloperidol Add-on Code, AMA Mod 51 Exempt B Optum Mod 51 Exempt a Mod 3 Exempt. Moderate edation Reequenced Code Note: For a complete explanation of each icon, pleae ee the Introduction CPT 201 American Medical Aociation. All Right Reerved. 201 Optum30, LLC