Gastroenterology Coding Alert

Question: What is the difference between facility and nonfacility relative value units (RVUs)?


Kansas Subscriber
Answer: The Centers for Medicare & Medicaid Services (CMS) assigns codes facility and nonfacility RVUs based on where the physician provides the service.

Nonfacility RVUs are used to calculate payment when the gastroenterologist provides a service in the office or clinic, while CMS applies facility RVUs when the gastroenterologist provides a service in a hospital or ambulatory surgery center.
 
The higher the RVUs, the more money your office can expect for the procedure or service. Nonfacility RVUs usually pay at a higher rate than facility RVUs because they include expenses.

For example, the gastroenterologist performs a colonoscopy with a submucosal saline injection (45381, Colonoscopy, flexible, proximal to splenic flexure; with directed submucosal injection[s], any substance). If the physician performs this procedure in the office, the RVUs are 12.58, but RVUs for the same procedure performed at a hospital are 6.13. Clinical and coding expertise for this issue provided by Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the CPT advisory panel; and Linda Parks, MA, CPC, CCP, CMSCS, an independent coding consultant in Marietta, Ga.