2

Evolution of MHS RVUs

•Development of MHS Development of MHS RVUsRVUs

•System Specific RVUsSystem Specific RVUs•Future of MHS RVUsFuture of MHS RVUs•QuestionsQuestions

3

Development of MHS RVUs

•Centers for Medicare & Medicaid Services (CMS)

•INGENIX•MHS Adjustments

4

CMS2005 National Physician Fee Schedule Relative Value File

CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

Dental codes (D codes) are copyright 2002 American Dental Association. All Rights Reserved.

FULLY FULLY FULLY FULLY

IMPLEMENTED IMPLEMENTED IMPLEMENTED IMPLEMENTED

STATUS WORK NON-FAC FACILITY MP NON-FACILITY FACILITY GLOB PRE INTRA POST

HCPCS MOD DESCRIPTION CODE RVU PE RVU PE RVU RVU TOTAL TOTAL DAYS OP OP OP

51785 Anal/urinary muscle study A 1.53 4.44 4.44 0.15 6.12 6.12 000 0.00 0.00 0.00

51785 TC Anal/urinary muscle study A 0.00 3.94 3.94 0.04 3.98 3.98 000 0.00 0.00 0.00

51785 26 Anal/urinary muscle study A 1.53 0.50 0.50 0.11 2.14 2.14 000 0.00 0.00 0.00

51792 Urinary reflex study A 1.10 5.99 5.99 0.20 7.29 7.29 000 0.00 0.00 0.00

51792 TC Urinary reflex study A 0.00 5.58 5.58 0.13 5.71 5.71 000 0.00 0.00 0.00

51792 26 Urinary reflex study A 1.10 0.41 0.41 0.07 1.58 1.58 000 0.00 0.00 0.00

51795 Urine voiding pressure study A 1.53 7.29 7.29 0.22 9.04 9.04 000 0.00 0.00 0.00

51795 TC Urine voiding pressure study A 0.00 6.79 6.79 0.10 6.89 6.89 000 0.00 0.00 0.00

51795 26 Urine voiding pressure study A 1.53 0.50 0.50 0.12 2.15 2.15 000 0.00 0.00 0.00

51797 Intraabdominal pressure test A 1.60 5.78 5.78 0.17 7.55 7.55 000 0.00 0.00 0.00

51797 TC Intraabdominal pressure test A 0.00 5.25 5.25 0.05 5.30 5.30 000 0.00 0.00 0.00

51797 26 Intraabdominal pressure test A 1.60 0.53 0.53 0.12 2.25 2.25 000 0.00 0.00 0.00

51798 Us urine capacity measure A 0.00 0.34 0.34 0.08 0.42 0.42 XXX 0.00 0.00 0.00

51800 Revision of bladder/urethra A 17.39 7.56 7.56 1.35 26.30 26.30 090 0.08 0.83 0.09

51820 Revision of urinary tract A 17.86 8.28 8.28 1.73 27.87 27.87 090 0.08 0.83 0.09

51840 Attach bladder/urethra A 10.69 5.56 5.56 1.07 17.32 17.32 090 0.08 0.83 0.09

5

INGENIX

HCPCS Mod Status DescriptionWork RVU

Non-Fac PE RVU

Fac PE RVU MP

Non-Fac Total

Fac Total

Global Days

51785 A NEEDLE EMG STDY ANAL/URETHRAL SPHIN 1.53 4.44 4.44 0.15 6.12 6.12 051785 26 A NEEDLE EMG STDY ANAL/URETHRAL SPHIN 1.53 0.5 0.5 0.11 2.14 2.14 051785 TC A NEEDLE EMG STDY ANAL/URETHRAL SPHIN 0 3.94 3.94 0.04 3.98 3.98 051792 A STIMULUS EVOKED RESPONSE 1.1 5.99 5.99 0.2 7.29 7.29 051792 26 A STIMULUS EVOKED RESPONSE 1.1 0.41 0.41 0.07 1.58 1.58 051792 TC A STIMULUS EVOKED RESPONSE 0 5.58 5.58 0.13 5.71 5.71 051795 A VOIDING PRESS STUDIES; BLADDER VOID 1.53 7.29 7.29 0.22 9.04 9.04 051795 26 A VOIDING PRESS STUDIES; BLADDER VOID 1.53 0.5 0.5 0.12 2.15 2.15 051795 TC A VOIDING PRESS STUDIES; BLADDER VOID 0 6.79 6.79 0.1 6.89 6.89 051797 A VOID PRSS STDY; INTRA-ABD VOID PRSS 1.6 5.78 5.78 0.17 7.55 7.55 051797 26 A VOID PRSS STDY; INTRA-ABD VOID PRSS 1.6 0.53 0.53 0.12 2.25 2.25 051797 TC A VOID PRSS STDY; INTRA-ABD VOID PRSS 0 5.25 5.25 0.05 5.3 5.3 051798 A MSR PVR U&/BLADD CAPACTY US NON-IMG 0 0.34 0.34 0.08 0.42 0.42 XXX51798 26 MSR PVR U&/BLADD CAPACTY US NON-IMG 0 0 0 0 0 0 XXX51798 TC MSR PVR U&/BLADD CAPACTY US NON-IMG 0 0.34 0.34 0.08 0.42 0.42 XXX51800 A CYSTOPLASTY/CYSTOURETHROPLASTY 17.39 7.56 7.56 1.35 26.3 26.3 9051820 A CYSTOURETHROPLASTY W/URETERONEOCYST 17.86 8.28 8.28 1.73 27.87 27.87 9051840 A ANT VESICOURETHRPXY/URETHRPXY; SMPL 10.69 5.56 5.56 1.07 17.32 17.32 90

6

MHS Adjustments

•High Frequency Ingenix Zero Weighted Codes

•Global Maternity•Global Surgery•Obsolete CPT Codes•Modifiers

7

High Freq Ingenix Zero Weighted Codes

• Top 85% SADR reported CPT codes with an INGENIX RVU of 0, excluding 99499 and ancillary.

• Provider Work• Specific Procedures• Groups/Families of CPT Codes• Timed Procedures

8

Provider Work

•Telcons (99371, 99372, 99373)

•Work Related Disability Exam by Treating Physician (99455)

•Administration of Flu Vaccine (G0008)

9

Specific Procedures

•Follow up to Surgery (99024)

•LASIK/PRK (S0800/S0810)•Prenatal and Postpartum Care Visits (0500F-0503F)

10

Global MaternityCPT Code Description Ingenix Work RVU MHS Work RVU

59400 Obstetrical Care 23.03 059410 Ob Care Incl Postpartum 14.76 059425 Antepartum Care Only (4-6 Encs) 4.8 059426 Antepartum Care Only (7+ Encs) 8.27 059510 Cesarean Delivery 26.18 059515 C-Sect Incl Postpartum 17.34 059610 Vbac Delivery 24.58 059614 Vbac Del After C-Sect 16.32 059618 Attempted Vbac Delivery 27.74 059622 Attempted Vbac Incl Postpartum 18.9 0

11

Global Surgery

Global Surgical Adjustment

SADR Coding

CPT Code Global Days Intr-Op % Old Work RVU New Work RVU51820 90 0.83 17.86 14.82

CPT Code Work RVUSADR #1 99213 0.67SADR #2 51820 14.82SADR #3 99024 0.63Total 16.12

Global 51820 17.86

12

Modifiers

DOD Modifiers00 Base Modifier21 Prolonged E&M

Service22 Unusual Procedural

Service26 Professional

Component32 Technical Component50 Bilateral Procedures51 Multiple Procedures90 External Laboratory99 Multiple Modifiers

INGENIX Modifiers(None) Base Modifier26 Professional

Component53 Discontinued

ProcedureNU New Durable

Medical EquipmentRR Rented Durable

Medical EquipmentUE Used Durable

Medical EquipmentTC Technical Component

13

DOD Radiology Modifiers-21 Prolonged E&M ServiceProfessional Component * 2

-22 Unusual Procedural ServiceProfessional Component + (Technical Component * 2)

-50 Bilateral Procedures(Professional Component * 2) + (Technical Component *

2)

-51 Multiple ProceduresTechnical Component * 2

-99 Multiple Modifiers(Professional Component * 2) + (Technical Component *

4)

14

System Specific RVUs

• MHS Data Repository (MDR)/M2– Direct Care (SADR)– Purchased Care (Non-

institutional HCSRs)– Ancillary

• EAS IV• CHCS

15

Direct Care – SADR RVUs

•Simple •Adjusted•PPS Work•PPS Facility• Individual Work •Organizational Work•Provider Work RVU

16

Relative Value Units (RVUs) in the MDR and M2

NameWeight Column

Discounting

Global Surgical

ReductionMultipleProviders

ProviderFilter

ProviderScaling

Comments Common Application

Simple Work No Yes No No No This is the only RVU field in claims, and is also in MTF

data.

Comparing claims to direct care.Used by some metric systems.

Adjusted Work 50% No No No No Older value retained to allow trending to early years.

Individual Work

Work 50%, E&M

Yes No Yes No FY03 on Best measure for individual productivity metrics.

Organizational Work

Work 50%, E&M

Yes Yes Yes No FY03 on Best measure for work center and above productivity metrics.

PPS Work Work E&M Yes Yes Yes No FY03 on Measures non-institutional burden (professional services).

PPS Facility Non-facility Practice Expense

E&M Yes No Yes No FY03 on Measures institutional burden excluding the provider.

Provider Work RVU

Work 50% No No Yes Yes FY04 and before (In MDR for FY05)

Older value retained to allow trending to early years.

17

Purchased Care - HCSRNI

Work RVUsNo Global Maternity AdjustmentNo Global Surgery Adjustment No RVUs for 99024, 0500F-0503FINGENIX Modifiers

18

CHCS and EAS IV• CHCS

MHS Adjusted RVUsDOD ModifiersWork RVU

• EAS IVSame initial construction as CHCS except,

Composite RVU = Work RVU + Non-Facility Practice Expense RVU

19

Future of MHS RVUs

20

Master RVU Table

CPT Mod WorkNon-facility

PEFacility

PEMalpractice

ExpGlobal Days Work

Non-facility PE

Facility PE

Care Flag

Adjusted RVU (DC)

78709 00 1.41 4.94 4.94 0.29 D 1.4178709 21 2.82 0.94 0.94 0.12 D 2.8278709 22 1.41 9.41 9.41 0.52 D 1.4178709 26 1.41 0.47 0.47 0.06 1.41 0.47 0.47 B 1.4178709 32 0.00 4.47 4.47 0.23 D 0.0078709 50 2.82 9.88 9.88 0.58 D 2.8278709 51 0.00 8.94 8.94 0.46 D 0.0078709 99 2.82 18.82 18.82 1.04 D 2.8278709 TC 0.23 0.00 4.47 4.47 P78709 0.29 1.41 4.94 4.94 P

Direct Care RVUs Purchased Care RVUs

21

EAS IV Repository Class 17

Raw statistical amount = number of proceduresWeighted statistical amount = number of procedures multiplied by the RVU weight Recommended that Class 17 be used in conjunction with Class 25

Ambulatory CPT Workload

22

EAS IV Repository Class 25

All records whether completed or not are fed through to EAS.

Class 25 contains a completion percentage that can be applied to adjust the dollars to the workload.

Ambulatory Summary (NO CPT)

23

EAS IV Repository Class 18Raw statistical amount = number of proceduresWeighted statistical amount = number of procedures multiplied by the RVU weight

Contains modifiers other than 00.

Ancillary CPT Workload

24

Questions?