Is anyone working with surgeons using WALANT? Note that this is not a specific CPT code but how you perform a host of procedures. The most common are hand and wrist procedures such as: carpal tunnel release, tendon repair and removal of masses. The issue is not the CPT code but where the surgery is performed and reimbursement. Since only local anesthesia is used, numerous surgeons around the country wish to perform the procedures in an office-based surgical suite (OBSS [POS=11]) instead of a facility (ASC, HOPD, or hospital).
Many 90-day surgical procedures are designated as "facility only." The “Non-Facility NA INDICATOR” flag in the PFSRVU database will have a status indicator of "NA". That means the Site-of-Service Differential (SOSD) equals zero and there is no additional reimbursement for the office surgical suite overhead. For many surgeons, that is a problem.
The solution is negotiating with each carrier a "carve out" for the OBSS overhead. While there are six direct and indirect components to the NON-FAC PE the easiest and most straightforward negotiating tactic is to ask for a percentage of the carriers total costs when the procedure is performed in a facility. The hospital is the most expensive, with the HOPD next and ASC last. But if you ask for 50% or 80% of the ASC facility costs you are still saving both the patient and the insurance company money.
Plus there are dozens of peer-reviewed research papers outlining the benefits of WALANT to the patient. For one, you can ask the patient to move his/her fingers during the operation; second, there are no general anesthesia pre-op expenses, actual costs, or recuperation issues.
Is anyone working with office-based-surgery (OBS), WALANT: (Wide Awake Local Anesthesia with No Tourniquet), or negotiating "carve-outs" for procedure codes with no Site-of-Service Differential (SOSD)?
Thanks
Many 90-day surgical procedures are designated as "facility only." The “Non-Facility NA INDICATOR” flag in the PFSRVU database will have a status indicator of "NA". That means the Site-of-Service Differential (SOSD) equals zero and there is no additional reimbursement for the office surgical suite overhead. For many surgeons, that is a problem.
The solution is negotiating with each carrier a "carve out" for the OBSS overhead. While there are six direct and indirect components to the NON-FAC PE the easiest and most straightforward negotiating tactic is to ask for a percentage of the carriers total costs when the procedure is performed in a facility. The hospital is the most expensive, with the HOPD next and ASC last. But if you ask for 50% or 80% of the ASC facility costs you are still saving both the patient and the insurance company money.
Plus there are dozens of peer-reviewed research papers outlining the benefits of WALANT to the patient. For one, you can ask the patient to move his/her fingers during the operation; second, there are no general anesthesia pre-op expenses, actual costs, or recuperation issues.
Is anyone working with office-based-surgery (OBS), WALANT: (Wide Awake Local Anesthesia with No Tourniquet), or negotiating "carve-outs" for procedure codes with no Site-of-Service Differential (SOSD)?
Thanks