RVU (Marselle/Britt/Russell)
This set of standard values was implemented in 1992 to regulate the compensation fees for physicians.
What is Relative Value Units (RVUs)?
The time period surrounding a surgical procedure during which all related post-operative care is included in the payment for the surgery.
What is surgical global period?
What is Relative Value Scale Update Committee
What does RUC stand for?
“This modifier can be used for a patient requiring a bilateral procedure.”
What is
-50
This term is an alternate name for bundled codes.
What are CCI edits?
These three components are included in a CPT Code
What is Work RVUs, Practice RVUs and Malpractice RVUs?
Know your global period.
The RUC makes recommendations, but this entity makes final payment decisions?
What is CMS (Centers for Medicare and Medicaid Services)
“This m can be used to explain the reason for an exam on the same day as requiring an intravitreal injection for neovascular AMD."
What is modifier -25.
When reviewing CMS bundle codes, this indicator on the CCI table indicates that there are circumstances when a pair of codes can be unbundled.
What is 1?
In 2023, Medicare set the final USD value for 2024 at $32.74
What is Conversion Factor?
The global period for a minor procedure.
What is 0 days or 10 days.
Based on recommendations from the RUC, payment for this ophthalmic surgery decreased starting in 2020.
What is cataract surgery?
“This modifier can be used to bill an exam on a patient found to have a ruptured globe needing same day operative repair.”
What is modifier -57.
This modifier is used to unbundle testing and procedures for separate structures, e.g. separate eyes.
What is modifier -59?
This ophthalmic procedure has the lowest paying RVUs
What is Gonioscopy?
The modifier used to indicate that an Evaluation and Management (E/M) service provided during a postoperative period is unrelated to the original procedure
What is Modifier 24.
In 1991, the RUC was created due to the difference in payment between these two entities.
What is primary care visits and specialist visits.
"What modifier is needed to explain why a YAG laser of the right eye should be paid when performed during the global period of cataract surgery of the same eye.”
What is modifier -78, with 70% Allowable
This indicator on the CCI table indicates you cannot unbundle the CCI edit as it is a mutually exclusive edit.
What is 0?
This ophthalmic surgery has the highest paying RVUs
What is Retinal Detachment Repair?
This modifier is applied when a patient has SSIOL surgery after complex cataract with broken capsule within 90 days.
What is modifier -58.
Historically, the RUC recommendations were accepted at 90% but more recently, the acceptance percentage changed to what percentage?
What is 75%
“In addition to laterality, this modifier can be used to bill for a unilateral serial PRP (67228) performed for PDR three weeks after the prior session.”
What is No additional modifier is needed, the CPT code for PRP describes serial procedures with a typical 10 day global period.
This example demonstrates that a macular OCT for macular degeneration cannot be billed on same day the fundus photos to document drusen.
What is bundled testing services?
Create an excel sheet or ID card with work RVUs or payer rules for top procedures.
What should a graduate from this program do as they start their new job.
Ask technicians to list the surgeries and postop end dates somewhere useful in the chart
What is creating a system to help me know if a patient is in any ophthalmology global period?
If I do a surgery in 30 minutes it’s because I spent 10 years learning how to do that in 30 minutes. You owe me for the years, not the minutes.
What is stop devaluing our work just because we have technological advances to get better results?
Tells the payer that all the drug was adminstered and none was discarded.
What does modifier -JZ do?
Repair of retinal detachment by scleral buckle and combined vitrectomy can only pay out as 67018 vitrectomy and not for a combined 67017 and 67018.
What is review your surgical CCI bundles that affect your practice.