Gastroenterology Coding Alert

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

Kansas Subscriber

Answer: CMS assigns codes facility and nonfacility RVUs based on where the physician provides the service. You'll see this variation in RVUs called "site-of-service differential."

Nonfacility RVUs are used to calculate payment when the gastroenterologist provides a service in the office or clinic. 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 the expenses required to perform the procedure within an office setting.

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 12.22, but RVUs for the same procedure performed at a hospital are 6.65. These are the national average without figuring in the geographical cost.