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CPT 52234 vs. 52224

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I hope someone can help me. Physician billed out 52224 and 52005. 52005 is bundled with prime procedure. After review of the op notes I feel that 52234 better describes the procedure performed. Looking at code information I noticed that 52234 carries RVU of only 6.91 whereas 52224 carries an RVU of 31.13. I researched a bit more and code edit says that 52224 is considered bundled with 52234 which leads me to believe that 52234 should carry at least the same if not more RVU value. I have never come across a situation where the bundled code is considered 5x higher in RVUs than the code it is bundled into. Does anyone have any info on this. These are considered non-facility charges done on an outpatient surgery basis.
Thank you.
 

mbort

True Blue
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2,338
Location
ENGLEWOOD/DENVER
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52224- the RVU 4.74 for is for facility...non-facility is the 31.13
52234- the RVU is 6.91 for both facility and non-facility.

The non-facility RVU's are based on procedures performed in the office therefore hold a much higher value than those performed in a hospital/facility type setting.

As for explaining why they are what they are and why the one cpt holds a higher value than one thats less invasive doesnt make sense to me either.

Afterthought..... Since the 52234 doesnt have a different RVU for non-facility, perhaps this isnt a code that is considered to be an "office based procedure"??
 
Messages
4,466
Location
Milwaukee WI
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Facility vs NonFacility

Mary,
You are so right! I'm so used to looking only at the facility based, since that's our practice, I just am "blind" to the non-facility RVUs.

Thanks for reminding me.

F Tessa Bartels, CPC, CPC-E/M
 
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