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Hand-and-wrist procedures lend themselves to WALANT (Wide Awake Local Anesthesia with No Tourniquet) where the surgeon can communicate with an awake patient and ask them to move their fingers during the operation to obtain immediate feedback.

Even though there are dozens of peer-reviewed research papers on WALANT and OBS, this trend is still fairly new in the United States—mostly due to AMA and Medicare policy as well as carrier reimbursement issues. Most WALANT procedures continue to be performed in the ASC, HOPD or hospital, which if more costly to the patient and to the entire healthcare system. Performing the same WALANT procedure in an OBSS is convenient, safe, and will save on total healthcare costs.

Roughly one-hundred hand and wrist procedures currently have a Site of Service Differential (SOSD) of zero (no reimbursement for direct and indirect OBSS expenses). Many of these are suitable for an OBSS. In particular the following:

  1. Flexor And Extensor Tendon Repair
  2. Tendon Transfer
  3. Dupuytren Contracture Release
  4. Trigger Finger And Carpal Tunnel Release
  5. Surgical Treatment of Metacarpal And Phalangeal Fractures.
As an example, Open Carpal Tunnel Release (OCTR), CPT code 64721, has an positive SOSD (RVU’s = .23) when performed in the office. But the reimbursement amount is just over $6.00!

Endoscopic Carpal Tunnel Release (ECTR), on the other hand, pays the same amount (NON-FAC PE and FAC PE = 7.51 RVU's) regardless of the Place of Service. There is no compensation for the OBSS overhead (SOSD=zero). This is the issue for ECTR and numerous other hand-and-wrist procedures.

The full list of hand and wrist procedures, where SOSD=zero is posted on the website: www.ioectr.com

I would love to communicate with anyone interested in or currently implementing an OBSS strategy for hand and wrist orthopedic procedures.

Thanks in advance.

- Jeff
 
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