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 breast reduction surgery. Is the RVU assigned to the code 19318 for one breast or for a bilateral procedure? So for example if the work RVU for 19318 is say 33.12, and I did only one breast would I have performed 33.12 RVUs of work? And similarly if I did a bilateral surgery would I have now done 66.24 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, just wrote an article about RVU compensation that was published in the Journal of Medical Practice Management that I think is mandatory reading for every surgeon. First, the RVUs you cite above are the CPT code total RVUs. Physician compensation plans should be based on physician work RVUs, not total RVUs. The physician work RVUs for 19318 are 16.03 in 2013 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 (19318, 19318-50) 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 (19318-50). 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 16.03 work RVUs for the first side and 8.02 work RVUs for the second side for a total of 24.05 work RVUs for the bilateral procedure.