Q We perform diagnostic and operative hysteroscopy in our office. How do we recoup our loss compared with the hospital? Can we bill a separate physician and technical component?
A The Medicare Resource-Based Relative Value Scale (RBRVS) normally allows a practice expense increase for procedures that may be performed in the office and require expensive equipment, but are more typically performed in the hospital. The Medicare Relative Value Unit (RVU) is 9.42 for code 58558 (Hysteroscopy, surgical; with sampling [biopsy] of endometrium and/or polypectomy, with or without D & C). For hysteroscopy procedures, there is no difference in the RVU for site of service—with 3 exceptions:
- Diagnostic hysteroscopy carries .65 more (RVUs) for the office setting.
- Endometrial ablation has 63.25 RVUs for the office setting, but only 9.66 for the hospital setting.
- Essure, a new hysteroscopic sterilization technology, carries 57.91 RVUs in the office setting.
The vastly increased RVU for the latter 2 procedures in the office setting covers the more expensive equipment needed.
Hysteroscopic procedures do not have a professional and technical component in the typical sense. Although you may have additional practice costs such as a dedicated treatment room or special equipment, these may not be accurately reflected in the allowable for the hysteroscopic procedure you perform in the office setting. The current RVU system does not allow for separate payment of a “facility fee”; all practice costs associated with performing the procedure are added into the practice expense portion of the RVU for each procedure. Although all payers bundle the surgical tray into the reimbursement for the procedure, consider negotiating for a “facility fee” that adequately covers your additional expenses, by pointing out that money will be saved when the hysteroscopy is performed in the office.