WorkRVU calculation

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LostDesire1989

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Hey, guys quick question about calculating wRVUs. I am a relatively recent fellow grad and in my practice, I am transitioning from salary to productivity. So here's my question:
Let's say I'm doing a Unilateral RFA from L3 -Sacral ala. How many wRVUs would that generate?
The CPT codes for Lumbar RFA are 64635 (3.32wRVU) and 64636(1.16 wRVU). With the 64636 how many times can it be used to generate wRVUs? Just once or per each addn'l level?

Thanks all! Look forward to hearing your responses.
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You are only going to be reimbursed for 2 levels per spine segment every rolling 6 months I think. If you do perform the procedure bilaterally You can bill for the other side at the same time however you need a 50 modifier which cuts the reimbursement in half for the other side.
 
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moving to this new model make sure you track your wRVUs on your own via a spreadsheet or something for at least 3 months to ensure they match up with what your employer is documenting.
 
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DOctorJay said:
moving to this new model make sure you track your wRVUs on your own via a spreadsheet or something for at least 3 months to ensure they match up with what your employer is documenting.
Click to expand...
Absolute, as an employee going private soon, they will not correctly record your wRVU and it will NEVER favor the physician so consider yourself warned that this model requires your attention surveillance to ensure you are fairly compensated.
 
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thecentral09 said:
Absolute, as an employee going private soon, they will not correctly record your wRVU and it will NEVER favor the physician so consider yourself warned that this model requires your attention surveillance to ensure you are fairly compensated.
Click to expand...
agree, i kept track of it for a full year and they're off by at least 300-400 if not more
 
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LostDesire1989 said:
Unilateral RFA from L3 -Sacral ala. How many wRVUs would that generate?
The CPT codes for Lumbar RFA are 64635 (3.32wRVU) and 64636(1.16 wRVU). With the 64636 how many times can it be used to generate wRVUs? Just once or per each addn'l level?
Click to expand...
If you're saying 3 facet joint levels L3-S1,
64635
64636x2

Bilateral would be:
64635-50
64636x4

If payers will only pay 2 facet joint levels, if you probably won't get reimbursed for those non-paying RVUs.
 
All of this should be in the contract (but never is). Some employers don't give you credit for bilateral. What if something is denied, do you get credit? Are you able to see everything?

If you do bilateral 64635 x 1 and 64636 x 2 you SHOULD get 8.46 work pellets ;-)
 
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RoloTomassi said:
If you're saying 3 facet joint levels L3-S1,
64635
64636x2

Bilateral would be:
64635-50
64636x4

If payers will only pay 2 facet joint levels, if you probably won't get reimbursed for those non-paying RVUs.
Click to expand...
Thank you for your answer. What, resources would y'all recommend for me to obtain to learn more about what each procedure would generate?
 
Alright for lumbar facet injections. If I were to do L3/4, L4/5, L5/S1. How many wRVUs would that be? The CPT codes are 64493 and 64494.
64493 for the first level and 64494 for each addn'l level. The 64493 is 1.52 wRVUs and the 64494 is 1.00 for each level. So for a unilateral it should generate 3.52. Correct? How much would it be for bilateral?
 
LostDesire1989 said:
Thank you for your answer. What, resources would y'all recommend for me to obtain to learn more about what each procedure would generate?
Click to expand...

PM me with your email address and I’ll send you my spreadsheet
 
LostDesire1989 said:
Alright for lumbar facet injections. If I were to do L3/4, L4/5, L5/S1. How many wRVUs would that be? The CPT codes are 64493 and 64494.
64493 for the first level and 64494 for each addn'l level. The 64493 is 1.52 wRVUs and the 64494 is 1.00 for each level. So for a unilateral it should generate 3.52. Correct? How much would it be for bilateral?
Click to expand...

Bilateral is 3.52 x 1.5

(As long as 3.52 is correct, I didn’t check that for you)
 
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LostDesire1989 said:
Alright for lumbar facet injections. If I were to do L3/4, L4/5, L5/S1. How many wRVUs would that be? The CPT codes are 64493 and 64494.
64493 for the first level and 64494 for each addn'l level. The 64493 is 1.52 wRVUs and the 64494 is 1.00 for each level. So for a unilateral it should generate 3.52. Correct? How much would it be for bilateral?
Click to expand...
You're forgetting about 64495 for the third level, not 64494 x2. But still correct about unilateral if 64495 is also 1.00.

I believe the above are right about bilateral. Modifier-50 usually means 1.5x. However, some payers want, say:
64493-LT
64493-RT
Not 64493-50. But still pay 50% on the -RT.
Not 100% sure how that affects your RVU count.
 
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DOctorJay said:
PM me with your email address and I’ll send you my spreadsheet
Click to expand...
Would you also mind sharing the spreadsheet with me? I tried sending you a PM but am unable to start a conversation with you.
 
I'm out of the office til Tuesday (where my spreadsheet is). I'll try to upload it to this thread when I get back. not sure why you guys can't message me.
 
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I’ll try to post it here on Tuesday
 
ok here is the spreadsheet

hopefully I didn't mess up the formatting.

start by using each month sheet at the bottom. click on the month sheet, then you'll probably have to update the dates at the top. once the month is completed copy and paste the last 2 columns into the first sheet labeled "SDN wRVU Tracker" in the appropriate month column. this will tally units and wRVUs with monthly totals at the bottom and yearly totals all the way to the right.
 

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LostDesire1989 said:
Hey, guys quick question about calculating wRVUs. I am a relatively recent fellow grad and in my practice, I am transitioning from salary to productivity. So here's my question:
Let's say I'm doing a Unilateral RFA from L3 -Sacral ala. How many wRVUs would that generate?
The CPT codes for Lumbar RFA are 64635 (3.32wRVU) and 64636(1.16 wRVU). With the 64636 how many times can it be used to generate wRVUs? Just once or per each addn'l level?

Thanks all! Look forward to hearing your responses
Click to expand...
L3 to sacral ala is a 3 level unilateral ablation. First level is 64635 (3.78 wrvu) and two additional levels would be 64636 x 2 units (1.16 x 2=2.32). Total wrvus for the procedure would be 6.1.

For your own education, if you end up doing a bilateral procedure, you have to use a -50 modifier. The kick in the balls here is that you only get 50% of the fee for the contralateral side. In addition, some payers do NOT pay for more than 2 levels bilaterally. You gotta love insurance companies. Everything they do makes perfect sense. :rolleyes:
 
LostDesire1989 said:
Alright for lumbar facet injections. If I were to do L3/4, L4/5, L5/S1. How many wRVUs would that be? The CPT codes are 64493 and 64494.
64493 for the first level and 64494 for each addn'l level. The 64493 is 1.52 wRVUs and the 64494 is 1.00 for each level. So for a unilateral it should generate 3.52. Correct? How much would it be for bilateral?
Click to expand...
If you target the L3/L4, L4/L5, and L5/S1 facet joints, that would be 64493 (1.52 wRVUs), 64494 (1 wRVU), and 64495 (1 wRVU). Total for a unilateral procedure would be 3.52 wRVUs. If you targeted these joints bilaterally, you have to use -50 modifier (i.e., 64493-50, 64494-50, and 64495-50). You only get 50% of the reimbursement for the contralateral side. So that comes out to a total of 5.28 wRVUs for a bilateral procedure.
 
thecentral09 said:
Absolute, as an employee going private soon, they will not correctly record your wRVU and it will NEVER favor the physician so consider yourself warned that this model requires your attention surveillance to ensure you are fairly compensated.
Click to expand...

This. I knew I was leaving the hospital when I was there, but the wRVUs were always intentionally botched to give me low numbers. Pretty sure it never worked in my favor. The numbers made no sense.
 
If you're switching from Salary to Productivity, make sure it works in your favor.
 
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