Calculating Physician Work RVUs

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Question:

I am confused about how to count RVUs particularly for bilateral procedures such as the bilateral burr holes for subdural hematomas. Is the RVU assigned to the code 61154 for one side or for a bilateral procedure? So for example if the work RVU for 61154 is 37.94, and I did only one side would I have performed 37.94 RVUs of work? And similarly if I did a bilateral surgery would I have now done 75.88 RVUs of work? I’m not sure my hospital is capturing my RVUs accurately and I really want to understand this.

Answer:

You are very wise to learn how RVUs impact your compensation – I wish more physicians would. My colleague, Sarah Wiskerchen, recently wrote an article about RVU compensation that was published in the Journal of Medical Practice Management (click here to access the article) that I think is mandatory reading for every surgeon. First, the RVUs you cite above are the CPT code total RVUs. Physician compensation plans are typically based on physician work RVUs, not total RVUs. The physician work RVUs for 61154 are 17.07 and that is for a unilateral procedure as described by the code.

Billing for bilateral procedures generally occurs in two types of format: 1) Line-item format listing each CPT code on a separate line and modifier 50 on the second code (61154 61154-50) and billing your full fee for each procedure, and 2) Bundled format listing the code on a single line with modifier 50 and doubling your fee (61154-50). Payors reimburse 50% of the allowable for the second side/bilateral procedure so in both formats your payment would be 150% of the allowable.

Your compensation formula likely includes modifier adjustments so that you would receive credit for 17.07 work RVUs for the first side and 8.54 work RVUs for the second side for a total of 25.61 work RVUs for the bilateral procedure.