RVUs for TMS

[mle3]

We will be starting TMS in our clinic and this is the first in this group. So we had lot of questions about billing and security. We sorted out most of the things but left with one question which is about RVUs. CPT codes 90867, 90868, 90869 have no RVU values. In that case, how do you negotiate the compensation with your employer?

If they compensate, what is a reasonable ask? This new TMS patient population will reduce my clinic RVUs because I have to spend time with mapping, remapping and be there if any kind of help needed for my technician.

Is it possible to use a "procedure code" and assign RVUs for each session?

Appreciate your thoughts.

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[splik]

This is a great question and just another reason wRVU compensation sucks. The VA uses Fairhealth's metrics for total RVUs for TMS. They don't have the wRVUs noted but you can extrapolate (typically between 66-82% of the tRVU). 90867 is 8.31, 90868 is 6.22, and 90869 is 8.67 total RVUs. TMS can be extremely lucrative (I was offered over $1000 for 90869 by one of the major insurers for example) so do not let yourself be screwed over.

 

[surfguy84]

Is a 90869 used for each TMS session?

 

[calvnandhobbs68]

Is a 90869 used for each TMS session?

90868 usually was my impression. 90869 is if you’re redetermining the motor threshold so should take longer than a routine 90868 visit.

Although it’s weird that 90867 would be lower RVUs than 90869.

 

[mle3]

I was told by the admin that there will be a decent number for the initial session (90867) and a "very small" number of RVU for the subsequent sessions (90868). But they did not give me the actual numbers yet. This conversation was done on Friday. I am curious what they will say. With your reply, I got some valuable information and knew what could be a reasonable negotiation. Thank you very much.

 

[psych_0]

This is a great question and just another reason wRVU compensation sucks. The VA uses Fairhealth's metrics for total RVUs for TMS. They don't have the wRVUs noted but you can extrapolate (typically between 66-82% of the tRVU). 90867 is 8.31, 90868 is 6.22, and 90869 is 8.67 total RVUs. TMS can be extremely lucrative (I was offered over $1000 for 90869 by one of the major insurers for example) so do not let yourself be screwed over.

There's not much information about this online. Your hospital gives the doc 8.31 per intake, 6.22 per follow-up visit, and 8.67 for an remapping visits? How much of your time is required on the follow-up visits that don't have re-mapping?

My hospital is asking us to participate in our new TMS program, but the wRVU amounts we're being offered are laughable compared to those numbers (~2 for intake, 1.5 for follow-up, ~1.8 for re-mapping). I'd like to bring some hard evidence to the negotiating table showing what other providers are getting. Where would I look?

 

[vanfanal]

Can anyone who is more in the know about TMS provide a little education on efficacy and evidence. My impression is that it’s another snake oil therapy, like the ketamine clinics, that’s mainly geared to towards milder mood issues but generates $$ for private clinics.
And in terms of evidence, anyone with more severe illness would still be better served with lithium augmentation or ECT.

Please let me know if I misunderstand.

 

[SmallBird]

Can anyone who is more in the know about TMS provide a little education on efficacy and evidence. My impression is that it’s another snake oil therapy, like the ketamine clinics, that’s mainly geared to towards milder mood issues but generates $$ for private clinics.
And in terms of evidence, anyone with more severe illness would still be better served with lithium augmentation or ECT.

Please let me know if I misunderstand.

I wouldn't call TMS or Ketamine snake-oil - both are effective treatments but massively over-used by inexperienced people trying to make money without providing comprehensive care.

 

[calvnandhobbs68]

Can anyone who is more in the know about TMS provide a little education on efficacy and evidence. My impression is that it’s another snake oil therapy, like the ketamine clinics, that’s mainly geared to towards milder mood issues but generates $$ for private clinics.
And in terms of evidence, anyone with more severe illness would still be better served with lithium augmentation or ECT.

Please let me know if I misunderstand.

People are wayyyy more willing to do TMS or ketamine than ECT. I mean, I don't necessarily blame them, ECT still sounds pretty scary, requires general anesthesia repeated times, can cause some pretty significant short term cognitive effects and people may have to take off work for weeks for an ECT course. Where you can just go do a couple weeks of ketamine infusions initially or go for 15 minutes to TMS in the middle of work for 4 weeks and not have too much of an impact on your life.

TMS certainly has evidence and there are starting to be far fewer cash only TMS clinics (so a lot less "salesman" stuff going on) due to insurance coverage. Ketamine (including IV) also has evidence but there are a lot of cash clinics out there due to basically no insurance coverage, so this turns into basically anyone with a few thousand bucks can go to a "ketamine clinic" usually run by an anesthesiologist/CRNA and go trip for an hour.