Fellow Members, Wondered if you could enlighten me as to why CMS has decided that Code 45388:Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed); is worth $3,000.00 + and any other code within the same range family is only valued around $400.00 - $600.00? I have been contacted by my C-team when they noticed the GI cost was extremely high. Contacted the local MAC First Coast Service Options, they did research and had to rely on the files they received from CMS for the fees, not knowing why it was so out of alignment, or if they knew of the increase. I was referred to the Final Rule for November 2015 which had the Fee schedule changes, nothing relating to the substantial increase in code 45388. This doesn't seem correct? We are considering the data input of the RVU is incorrect, however when looking at other MACs they have the same RVU with fees similar to local MAC.

I find it highly irregular that CMS would increase the fee for the same procedure performed in 2014 45383 from $400.00 +/- to well over $3,000.00 +/- in 2016?? Any assistance with the reasoning behind this would be very helpful and put my administrators including CMO, and CEO at ease. If the increase was justified, they would like to know reasoning behind it, if it is an error, we could then proceed to make corrections. Thank you in advance for your assistance. Costa RHIT, CPC, CDIP Holly Hill, FL. Maybe it is because the instrument - laser is so expensive to purchase.

I have often come across incorrect coding when I have read the op report closely. Sometimes physicians get confused with ablation and removal. It is generally accepted that if the CPT code 45388: Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed); is being utilized, the polyp(s), tumor(s), or other lesion(s) are ablated with laser. Nothing is left over to be removed. If a physician states in the op note that he ablated polyps, tumors or other lesions and removed them via snare, that is technically not 45388, but 45385.

Laser equipment is extremely expensive. That is only my opinion why CMS has such a high fee for this code. Fellow Members, Wondered if you could enlighten me as to why CMS has decided that Code 45388:Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed); is worth $3,000.00 + and any other code within the same range family is only valued around $400.00 - $600.00? I have been contacted by my C-team when they noticed the GI cost was extremely high. Contacted the local MAC First Coast Service Options, they did research and had to rely on the files they received from CMS for the fees, not knowing why it was so out of alignment, or if they knew of the increase.

I was referred to the Final Rule for November 2015 which had the Fee schedule changes, nothing relating to the substantial increase in code 45388. This doesn't seem correct? We are considering the data input of the RVU is incorrect, however when looking at other MACs they have the same RVU with fees similar to local MAC. I find it highly irregular that CMS would increase the fee for the same procedure performed in 2014 45383 from $400.00 +/- to well over $3,000.00 +/- in 2016?? Any assistance with the reasoning behind this would be very helpful and put my administrators including CMO, and CEO at ease. If the increase was justified, they would like to know reasoning behind it, if it is an error, we could then proceed to make corrections.

Thank you in advance for your assistance. Costa RHIT, CPC, CDIP Holly Hill, FL. I can't access the in depth RVU breakdown from 2014 (i use find a code and there is a ton of cost basis info behind the RVU calculation) but for instance with today's codes: 45388 requires use of 'radiofrequency generator, endoscopy' w/ average purchase price of $108,000 w/ 5 years of equipment life which is additional to say what is needed equipment wise w/ the snare.

There is an additional direct supplies expense for 'catheter, RF ablation, endoscopic' which on average costs $1,700 on top of supplies for snare removal. I attached PE RVU breakdown of 45385 (snare technique) vs 45388 (RFA technique). Maybe it is because the instrument - laser is so expensive to purchase. I have often come across incorrect coding when I have read the op report closely.

Sometimes physicians get confused with ablation and removal. It is generally accepted that if the CPT code 45388: Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed); is being utilized, the polyp(s), tumor(s), or other lesion(s) are ablated with laser. Nothing is left over to be removed. If a physician states in the op note that he ablated polyps, tumors or other lesions and removed them via snare, that is technically not 45388, but 45385. Laser equipment is extremely expensive.

That is only my opinion why CMS has such a high fee for this code.Thank you for this information, now the fee associated with this code starts to make sense. Will convey to administration so we can make adjustments. I can't access the in depth RVU breakdown from 2014 (i use find a code and there is a ton of cost basis info behind the RVU calculation) but for instance with today's codes: 45388 requires use of 'radiofrequency generator, endoscopy' w/ average purchase price of $108,000 w/ 5 years of equipment life which is additional to say what is needed equipment wise w/ the snare. There is an additional direct supplies expense for 'catheter, RF ablation, endoscopic' which on average costs $1,700 on top of supplies for snare removal. I attached PE RVU breakdown of 45385 (snare technique) vs 45388 (RFA technique) Coding King, Thank you for all the information including the file with RVU breakdown, this was very helpful as sometimes visuals are the best form of communication.

This really shows why the fee is so high. Close Message In addition to full participation on AAPC forums, as a member you will be able to:. Access to the largest healthcare job database in the world.

Join over 150,000 members of the healthcare network in the world. Be a part of an industry leading organization that drives the business side of healthcare. Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences. Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance. Become a member of a local chapter and attend regular meetings. Search Engine Optimisation provided by - Copyright © 2018 DragonByte Technologies Ltd.

Disclaimer: Although AAPC staff members will monitor these forums periodically, we cannot be responsible for the information posted herein, nor guarantee its accuracy. Our members may discuss various subjects related to medical coding, but none of the information should replace the independent judgment of a physician for any given health issue. Please note that the opinions expressed here do not necessarily reflect those of AAPC.

Copyright © 2017, AAPC.

Productivity matters! Let iRVU track RVUs for you.Physician income relies on productivity.

List Of Rvu Values

You are logged in as. Please submit your review for iRVU: Hospital - Inpatient physician productivity as RVUs, charges, and compensation 1. Rate this product: 2. One-line summary: (10 characters minimum) Count: 0 of 55 characters 3. Pros: (10 characters minimum) Count: 0 of 1,000 characters 4. Cons: (10 characters minimum) Count: 0 of 1,000 characters 5. Summary: (optional) Count: 0 of 1,500 characters The posting of advertisements, profanity, or personal attacks is prohibited.

What Is A Work Rvu

To review our site terms of use.