RVU Boosters

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VentdependenT

VentdependenT

You didnt build thaT
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Some interesting things i've learned:
Central line 2.5
Thoracentesis 1.5
LP 1.4
Paracentesis 1.3
Smoking cessation 11min 0.5
Smoking cessation 4 min 0.25

Navigational is not worth it but I perform them to help folks avoid serious morbidity.

I will never waste my time doing another thoracentesis ever unless its a weekend and i wanna reallly get someone off the vent.

I can tag on smoking cessation to 3 notes and make more than the 30-45 painful minutes it takes to go through all the crap to do a thora.

Others:
-always put "therapeutic aspiration of secretions"
on bronch note.

I document well and efficiently and EPIC is a huge plus. Just thought i'd ask about what sone of you do to increase RVU's. Was shocked at how little revenue a relatively dangerous procedure generates.
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NAV with brushing, needle, and biopsy of a lesion and then EBUS staging is worth the couple of hours relatively speaking (assuming you are comparing your time to critical care time), especially if you place fiducial markers.

I personally will not add therapeutic aspiration of secretions unless that is what I actually did.

Agree about thoras or paras. Central lines aren't even worth the time usually by th time it's all said and done.

Running a code has good rvu.

But mostly it kind of sucks. Would be nice if level three in patient returns gave more.
 
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VentdependenT said:
Some interesting things i've learned:
Central line 2.5
Thoracentesis 1.5
LP 1.4
Paracentesis 1.3
Smoking cessation 11min 0.5
Smoking cessation 4 min 0.25

Navigational is not worth it but I perform them to help folks avoid serious morbidity.

I will never waste my time doing another thoracentesis ever unless its a weekend and i wanna reallly get someone off the vent.

I can tag on smoking cessation to 3 notes and make more than the 30-45 painful minutes it takes to go through all the crap to do a thora.

Others:
-always put "therapeutic aspiration of secretions"
on bronch note.

I document well and efficiently and EPIC is a huge plus. Just thought i'd ask about what sone of you do to increase RVU's. Was shocked at how little revenue a relatively dangerous procedure generates.
Click to expand...

How can you bill that smoking cessation11 mins? Do you need to specify the time on the note?
I have my counseling speech that I tell patients and modify on a case by case basis.



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VentdependenT said:
Some interesting things i've learned:
Central line 2.5
Thoracentesis 1.5
LP 1.4
Paracentesis 1.3
Smoking cessation 11min 0.5
Smoking cessation 4 min 0.25

Navigational is not worth it but I perform them to help folks avoid serious morbidity.

I will never waste my time doing another thoracentesis ever unless its a weekend and i wanna reallly get someone off the vent.

I can tag on smoking cessation to 3 notes and make more than the 30-45 painful minutes it takes to go through all the crap to do a thora.

Others:
-always put "therapeutic aspiration of secretions"
on bronch note.

I document well and efficiently and EPIC is a huge plus. Just thought i'd ask about what sone of you do to increase RVU's. Was shocked at how little revenue a relatively dangerous procedure generates.
Click to expand...

Are these work RVUs or RVUs?
 
tartesos said:
How can you bill that smoking cessation11 mins? Do you need to specify the time on the note?
I have my counseling speech that I tell patients and modify on a case by case basis.

Sent from my iPhone using SDN mobile app
Click to expand...

Yes. You specify in your note. I use a separate paragraph and have my dragon blow it in. And this is it:

"Patient's smoking was discussed and counseled to quit and reasons that this would benefit the patient were given. Smoking aids were offered and refused by the patient at this time. I spent more than 3 minutes and less than 10 minutes discussing smoking cessation. I will continue discuss this issue with the patient at every visit."

Since I almost never spend more than 10 minutes discussing it and I think it would be hard for any auditor to actually believe I always spent MORE than 10 minutes, I don't document more than 10. I edit the bit in the middle if it is appropriate.
 
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jdh71 said:
Yes. You specify in your note. I use a separate paragraph and have my dragon blow it in. And this is it:

"Patient's smoking was discussed and counseled to quit and reasons that this would benefit the patient were given. Smoking aids were offered and refused by the patient at this time. I spent more than 3 minutes and less than 10 minutes discussing smoking cessation. I will continue discuss this issue with the patient at every visit."

Since I almost never spend more than 10 minutes discussing it and I think it would be hard for any auditor to actually believe I always spent MORE than 10 minutes, I don't document more than 10. I edit the bit in the middle if it is appropriate.
Click to expand...

Thanks man!
Looks good! Will put mine in dragon as well, only need to add the time thing to my "speech".




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Hmm, I've never checked to see I can put smoking cessation counselling for parents in my note. I think it would go like this:

"Parent/caregiver smoking was discussed and counseled to quit as they are slowly and directly harming their children. Smoking aids were offered including gluing nicotine patches to forehead with the slogan "I smoke because I'm a terrible parent". I spent more than 3 minutes and less than 10 minutes discussing smoking cessation. I will continue discuss this issue with the parent/caregiver at every admission of their children which will be frequent due to their foolish, self-serving behavior "
 
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SurfingDoctor said:
Hmm, I've never checked to see I can put smoking cessation counselling for parents in my note. I think it would go like this:

"Parent/caregiver smoking was discussed and counseled to quit as they are slowly and directly harming their children. Smoking aids were offered including gluing nicotine patches to forehead with the slogan "I smoke because I'm a terrible parent". I spent more than 3 minutes and less than 10 minutes discussing smoking cessation. I will continue discuss this issue with the parent/caregiver at every admission of their children which will be frequent due to their foolish, self-serving behavior "
Click to expand...


Lol That will end up on the web. But Do eeeeet!


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just went to a FL state mandatory smoking cessation course. stated all they wanted for documentation is:
1. why they started
2. are they ready to quit
3. see your PCP or here are the tools when you're ready

simple sentence of : started years ago and became a habit, no not ready at this time, I understand I'll tell my pcp when ready

I didn't know about the time requirements....seems like the govt is even trying to cut back on reimbursement on this!
 
MSmentor018 said:
just went to a FL state mandatory smoking cessation course. stated all they wanted for documentation is:
1. why they started
2. are they ready to quit
3. see your PCP or here are the tools when you're ready

simple sentence of : started years ago and became a habit, no not ready at this time, I understand I'll tell my pcp when ready

I didn't know about the time requirements....seems like the govt is even trying to cut back on reimbursement on this!
Click to expand...

That is not the requirements for smoking cessation billing, not even remotely close.
 
Advanced care planning codes:

I'm not CC but I've used this when I am discussing advanced directives, hospice, living will, and other planning in this manner. You have to spend over 30 min talking with the patient which is hard to do but it can make some of the long family discussions actually pay something.

99497 RVU 2.4
99498 RVU 2.09
 
InvestingDoc said:
Advanced care planning codes:

I'm not CC but I've used this when I am discussing advanced directives, hospice, living will, and other planning in this manner. You have to spend over 30 min talking with the patient which is hard to do but it can make some of the long family discussions actually pay something.

99497 RVU 2.4
99498 RVU 2.09
Click to expand...

Eh, I wouldn't say 30 minutes on a goals of care discussion is hard to do. Seems like this comes up at least once a week. And when it comes up, it usually comes up multiple days in a row.
 
InvestingDoc said:
Advanced care planning codes:

I'm not CC but I've used this when I am discussing advanced directives, hospice, living will, and other planning in this manner. You have to spend over 30 min talking with the patient which is hard to do but it can make some of the long family discussions actually pay something.

99497 RVU 2.4
99498 RVU 2.09
Click to expand...

Yeah but can you bill for this on top of other billing.

Plus if it's critical care orientated you can just tack on the convo to the whole time spent going critical care.
 
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.birdstruck
 
Last edited:
jdh71 said:
Yeah but can you bill for this on top of other billing.

Plus if it's critical care orientated you can just tack on the convo to the whole time spent going critical care.
Click to expand...

The problem one of our billers has told us is that we can only bill CC time when on the unt per CMS. When I go somewhere else for say a family meeting, or if I go to my office to write my notes, supposedly we can't bill CC time then because we were not in the unit. Any insight as to if this is true?


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G-Man82 said:
The problem one of our billers has told us is that we can only bill CC time when on the unt per CMS. When I go somewhere else for say a family meeting, or if I go to my office to write my notes, supposedly we can't bill CC time then because we were not in the unit. Any insight as to if this is true?


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Click to expand...

I've not had my biller say anything like that. I don't know why it would matter where it happened.
 
G-Man82 said:
The problem one of our billers has told us is that we can only bill CC time when on the unt per CMS. When I go somewhere else for say a family meeting, or if I go to my office to write my notes, supposedly we can't bill CC time then because we were not in the unit. Any insight as to if this is true?
Click to expand...

https://www.acep.org/Physician-Reso...ial-Issues-/-Reimbursement/Critical-Care-FAQ/

I've never seen any requirement to this affect, when I am on consult service I bill CCT all over the hospital, as long as I spend >30 minutes directly involved in the care of that patient and they need the other criteria. Family meetings if done on same unit of the patient count. The key is "immediately available" if your office of family meeting isn't on the same floor then no cct for you.
 
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jdh71 said:
I've not had my biller say anything like that. I don't know why it would matter where it happened.
Click to expand...

I've been told this by one of my medical directors. He explicitly said you can't bill CC time for documentation if you do your charts at home.
 
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