Transcript Evolution of Military Health System Relative Value Units

Evolution of MHS RVUs
• Development of MHS RVUs
• System Specific RVUs
• Future of MHS RVUs
• Questions
2
Development of MHS RVUs
• Centers for Medicare &
Medicaid Services (CMS)
• INGENIX
• MHS Adjustments
3
CMS
2005 National Physician Fee Schedule Relative Value File
CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.
Dental codes (D codes) are copyright 2002 American Dental Association. All Rights Reserved.
STATUS WORK
HCPCS MOD
FULLY
FULLY
FULLY
FULLY
IMPLEMENTED
IMPLEMENTED
IMPLEMENTED
IMPLEMENTED
NON-FAC
FACILITY
MP
NON-FACILITY
FACILITY
GLOB PRE INTRA POST
DESCRIPTION
CODE
RVU
PE RVU
PE RVU
RVU
TOTAL
TOTAL
DAYS
OP
OP
OP
Anal/urinary muscle study
A
1.53
4.44
4.44
0.15
6.12
6.12
000
0.00
0.00
0.00
51785
TC
Anal/urinary muscle study
A
0.00
3.94
3.94
0.04
3.98
3.98
000
0.00
0.00
0.00
51785
26
Anal/urinary muscle study
A
1.53
0.50
0.50
0.11
2.14
2.14
000
0.00
0.00
0.00
Urinary reflex study
A
1.10
5.99
5.99
0.20
7.29
7.29
000
0.00
0.00
0.00
51785
51792
51792
TC
Urinary reflex study
A
0.00
5.58
5.58
0.13
5.71
5.71
000
0.00
0.00
0.00
51792
26
Urinary reflex study
A
1.10
0.41
0.41
0.07
1.58
1.58
000
0.00
0.00
0.00
Urine voiding pressure study
A
1.53
7.29
7.29
0.22
9.04
9.04
000
0.00
0.00
0.00
51795
51795
TC
Urine voiding pressure study
A
0.00
6.79
6.79
0.10
6.89
6.89
000
0.00
0.00
0.00
51795
26
Urine voiding pressure study
A
1.53
0.50
0.50
0.12
2.15
2.15
000
0.00
0.00
0.00
Intraabdominal pressure test
A
1.60
5.78
5.78
0.17
7.55
7.55
000
0.00
0.00
0.00
51797
51797
TC
Intraabdominal pressure test
A
0.00
5.25
5.25
0.05
5.30
5.30
000
0.00
0.00
0.00
51797
26
Intraabdominal pressure test
A
1.60
0.53
0.53
0.12
2.25
2.25
000
0.00
0.00
0.00
51798
Us urine capacity measure
A
0.00
0.34
0.34
0.08
0.42
0.42
XXX 0.00
0.00
0.00
51800
Revision of bladder/urethra
A
17.39
7.56
7.56
1.35
26.30
26.30
090
0.08
0.83
0.09
51820
Revision of urinary tract
A
17.86
8.28
8.28
1.73
27.87
27.87
090
0.08
0.83
0.09
51840
Attach bladder/urethra
A
10.69
5.56
5.56
1.07
17.32
17.32
090
0.08
0.83
0.09
4
INGENIX
HCPCS Mod Status
Description
51785
A
NEEDLE EMG STDY ANAL/URETHRAL SPHIN
51785 26
A
NEEDLE EMG STDY ANAL/URETHRAL SPHIN
51785 TC
A
NEEDLE EMG STDY ANAL/URETHRAL SPHIN
51792
A
STIMULUS EVOKED RESPONSE
51792 26
A
STIMULUS EVOKED RESPONSE
51792 TC
A
STIMULUS EVOKED RESPONSE
51795
A
VOIDING PRESS STUDIES; BLADDER VOID
51795 26
A
VOIDING PRESS STUDIES; BLADDER VOID
51795 TC
A
VOIDING PRESS STUDIES; BLADDER VOID
51797
A
VOID PRSS STDY; INTRA-ABD VOID PRSS
51797 26
A
VOID PRSS STDY; INTRA-ABD VOID PRSS
51797 TC
A
VOID PRSS STDY; INTRA-ABD VOID PRSS
51798
A
MSR PVR U&/BLADD CAPACTY US NON-IMG
51798 26
MSR PVR U&/BLADD CAPACTY US NON-IMG
51798 TC
MSR PVR U&/BLADD CAPACTY US NON-IMG
51800
A
CYSTOPLASTY/CYSTOURETHROPLASTY
51820
A
CYSTOURETHROPLASTY W/URETERONEOCYST
51840
A
ANT VESICOURETHRPXY/URETHRPXY; SMPL
Work
RVU
1.53
1.53
0
1.1
1.1
0
1.53
1.53
0
1.6
1.6
0
0
0
0
17.39
17.86
10.69
Non-Fac
PE RVU
4.44
0.5
3.94
5.99
0.41
5.58
7.29
0.5
6.79
5.78
0.53
5.25
0.34
0
0.34
7.56
8.28
5.56
Fac PE
RVU
4.44
0.5
3.94
5.99
0.41
5.58
7.29
0.5
6.79
5.78
0.53
5.25
0.34
0
0.34
7.56
8.28
5.56
MP
0.15
0.11
0.04
0.2
0.07
0.13
0.22
0.12
0.1
0.17
0.12
0.05
0.08
0
0.08
1.35
1.73
1.07
Non-Fac
Total
6.12
2.14
3.98
7.29
1.58
5.71
9.04
2.15
6.89
7.55
2.25
5.3
0.42
0
0.42
26.3
27.87
17.32
Fac
Total
6.12
2.14
3.98
7.29
1.58
5.71
9.04
2.15
6.89
7.55
2.25
5.3
0.42
0
0.42
26.3
27.87
17.32
Global
Days
0
0
0
0
0
0
0
0
0
0
0
0
XXX
XXX
XXX
90
90
90
5
MHS Adjustments
• High Frequency Ingenix Zero
Weighted Codes
• Global Maternity
• Global Surgery
• Obsolete CPT Codes
• Modifiers
6
High Freq Ingenix Zero Weighted Codes
• Top 85% SADR reported CPT codes with an
•
•
•
•
INGENIX RVU of 0, excluding 99499 and
ancillary.
Provider Work
Specific Procedures
Groups/Families of CPT Codes
Timed Procedures
7
Provider Work
• Telcons (99371, 99372, 99373)
• Work Related Disability Exam by
Treating Physician (99455)
• Administration of Flu Vaccine
(G0008)
8
Specific Procedures
• Follow up to Surgery (99024)
• LASIK/PRK (S0800/S0810)
• Prenatal and Postpartum Care
Visits (0500F-0503F)
9
Global Maternity
CPT Code
Description
59400
Obstetrical Care
59410
Ob Care Incl Postpartum
59425
Antepartum Care Only (4-6 Encs)
59426
Antepartum Care Only (7+ Encs)
59510
Cesarean Delivery
59515
C-Sect Incl Postpartum
59610
Vbac Delivery
59614
Vbac Del After C-Sect
59618
Attempted Vbac Delivery
59622
Attempted Vbac Incl Postpartum
Ingenix Work RVU
23.03
14.76
4.8
8.27
26.18
17.34
24.58
16.32
27.74
18.9
MHS Work RVU
0
0
0
0
0
0
0
0
0
0
10
Global Surgery
Global Surgical Adjustment
CPT Code Global Days Intr-Op % Old Work RVU
51820
90
0.83
17.86
New Work RVU
14.82
SADR Coding
CPT Code
SADR #1 99213
SADR #2 51820
SADR #3 99024
Total
Global
51820
Work RVU
0.67
14.82
0.63
16.12
17.86
11
Modifiers
DOD Modifiers
00 Base Modifier
21 Prolonged E&M Service
22 Unusual Procedural
Service
26 Professional Component
32 Technical Component
50 Bilateral Procedures
51 Multiple Procedures
90 External Laboratory
99 Multiple Modifiers
INGENIX Modifiers
(None) Base Modifier
26 Professional Component
53 Discontinued Procedure
NU New Durable Medical
Equipment
RR Rented Durable Medical
Equipment
UE Used Durable Medical
Equipment
TC Technical Component
12
DOD Radiology Modifiers
-21 Prolonged E&M Service
Professional Component * 2
-22 Unusual Procedural Service
Professional Component + (Technical Component * 2)
-50 Bilateral Procedures
(Professional Component * 2) + (Technical Component * 2)
-51 Multiple Procedures
Technical Component * 2
-99 Multiple Modifiers
(Professional Component * 2) + (Technical Component * 4)
13
System Specific RVUs
• MHS Data Repository (MDR)/M2
– Direct Care (SADR)
– Purchased Care (Non-institutional
HCSRs)
– Ancillary
• EAS IV
• CHCS
14
Direct Care – SADR RVUs
•
•
•
•
•
•
•
Simple
Adjusted
PPS Work
PPS Facility
Individual Work
Organizational Work
Provider Work RVU
15
Relative Value Units (RVUs) in the MDR and M2
Global
Surgical
Reduction
Multiple
Providers
No
Yes
No
Work
50%
No
No
No
No
Individual
Work
Work
50%,
E&M
Yes
No
Yes
No
FY03 on
Best measure for individual
productivity metrics.
Organizational
Work
Work
50%,
E&M
Yes
Yes
Yes
No
FY03 on
Best measure for work center
and above productivity metrics.
PPS Work
Work
E&M
Yes
Yes
Yes
No
FY03 on
Measures non-institutional
burden (professional services).
PPS Facility
Nonfacility
Practice
Expense
E&M
Yes
No
Yes
No
FY03 on
Measures institutional burden
excluding the provider.
Provider Work
RVU
Work
50%
No
No
Yes
Yes
FY04 and before
(In MDR for FY05)
Older value retained to allow
trending to early years.
Name
Weight
Column
Discounting
Simple
Work
Adjusted
Provider
Filter
No
Provider
Scaling
No
Comments
This is the only
RVU field in claims,
and is also in MTF
data.
Common Application
Comparing claims to direct
care.
Used by some metric systems.
Older value retained to allow
trending to early years.
16
Purchased Care - HCSRNI
Work RVUs
No Global Maternity Adjustment
No Global Surgery Adjustment
No RVUs for 99024, 0500F-0503F
INGENIX Modifiers
17
CHCS and EAS IV
• CHCS
MHS Adjusted RVUs
DOD Modifiers
Work RVU
• EAS IV
Same initial construction as CHCS except,
Composite RVU = Work RVU + Non-Facility Practice
Expense RVU
18
Future of MHS RVUs
19
Master RVU Table
Direct Care RVUs
CPT Mod Work
78709
78709
78709
78709
78709
78709
78709
78709
78709
78709
00
21
22
26
32
50
51
99
TC
1.41
2.82
1.41
1.41
0.00
2.82
0.00
2.82
Non-facility
PE
4.94
0.94
9.41
0.47
4.47
9.88
8.94
18.82
Purchased Care RVUs
Adjusted
Facility Malpractice Global
Non-facility Facility Care RVU
PE
Exp
Days Work
PE
PE
Flag (DC)
4.94
0.94
9.41
0.47
4.47
9.88
8.94
18.82
0.29
0.12
0.52
0.06
0.23
0.58
0.46
1.04
0.23
0.29
1.41
0.47
0.00
1.41
4.47
4.94
D
D
D
0.47 B
D
D
D
D
4.47 P
4.94 P
1.41
2.82
1.41
1.41
0.00
2.82
0.00
2.82
20
EAS IV Repository Class 17
Ambulatory CPT Workload
Raw statistical amount =
number of procedures
Weighted statistical amount =
number of procedures
multiplied by the RVU weight
Recommended that Class 17
be used in conjunction with
Class 25
21
EAS IV Repository Class 25
Ambulatory Summary (NO CPT)
All records whether
completed or not are fed
through to EAS.
Class 25 contains a
completion percentage that
can be applied to adjust the
dollars to the workload.
22
EAS IV Repository Class 18
Ancillary CPT Workload
Raw statistical amount =
number of procedures
Weighted statistical amount =
number of procedures
multiplied by the RVU weight
Contains modifiers other than
00.
23
Questions?
24