Hybrocure
There will come a payday
- Joined
- May 11, 2023
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$400Charged and collected are totally different things. What did he collect?
$400Charged and collected are totally different things. What did he collect?
It’s impossible if they weren’tIt’s totally possible they were including their clinic production as well.
It doesn’tNot sure how insurance offsets that charge though and how that affects RVU production.
Most patients cannot be managed outpatient because they have no insurance or they are underinsured or they have state insurance and live hours away. Once you decide to admit them and they agree then it's a one stop shop getting hospitalists (to manage the other unknown diagnosis), ID, vascular, cardiac etc. We have to remember that these patients have a lot of unknown diagnosis. Basically like a walking deadYup. A non septic osteo patient can be managed completely outpatient. I think hospitals are catching on to pods admitting non septic ulcer patients just to collect rounding money from the residents work every day.
Too many pods have a new ulcer patient come in to their clinic with a red toe and ulcer probing to bone and just call for an admit rather than start oral abx, imaging, or schedule for an outpatient amp.
Pro tip: 95% of podiatrists lie about income. 5% are silent on income.It’s totally possible they were including their clinic production as well. However, one of the cases charged over 6k when they were showing me what they billed and the hospital charges. Not sure how insurance offsets that charge though and how that affects RVU production. Reattaching a partially detached big toe (trauma, healthy patient, hope it survives).
What about the microvascular repair for wearing loupesPro tip: 95% of podiatrists lie about income. 5% are silent on income.
And that is why the income surveys are even sadder than they appear.
...Toe replant is just codes for flexor repair, extensor repair, open fx hallux tx, I&D, etc... all after first CPT would get reduced/denied (open fx would probably be your first line code). I bet it'd pay $2k max for me (so charge $6k maybe), and I have very good insurance area. Replant of foot code would pay maybe $3k... wRVU are not too far off usually (less RVUs for the CPT but usually paid around 2x rate of facility RVUs... work RVU sometimes not reduced for multiple CPTs though, so that helps).
Doesn't matter... it all pays the same. Loupes pay nothing extra... simply surgeon pref for some stuff.What about the microvascular repair for wearing loupes
What about the microvascular repair for wearing loupes
I’m not sure, I was just trolling about pods who throw on loupes and say they did a micro repair just cuz they made it look like they did when all they do is tie a couple pieces of fascia together shrug and say voilaI scrubbed with a hand surgery team where we replanted a thumb, started at 8pm and took 6 hours with 2 surgeons and a microscope. What is the quality of repair with a single surgeon using loupes?
Pro tip: 95% of podiatrists lie about income. 5% are silent on income.
And that is why the income surveys are even sadder than they appear.
...Toe replant is just codes for flexor repair, extensor repair, open fx hallux tx, I&D, etc... all after first CPT would get reduced/denied (open fx would probably be your first line code). I bet it'd pay $2k max for me (so charge $6k maybe), and I have very good insurance area. Replant of foot code would pay maybe $3k... wRVU are not too far off usually (less RVUs for the CPT but usually paid around 2x rate of facility RVUs... work RVU sometimes not reduced for multiple CPTs though, so that helps).
I scrubbed with a hand surgery team where we replanted a thumb, started at 8pm and took 6 hours with 2 surgeons and a microscope. What is the quality of repair with a single surgeon using loupes?
That’s sort of the point, we have no business replanting toes. Either do it right and do it well or not at allWell a thumb is just a little more important from a function standpoint than any toe so…who cares if a toe replant is done well or not?
That’s sort of the point, we have no business replanting toes. Either do it right and do it well or not at all
Reattaching a partially detached big toe (trauma, healthy patient, hope it survives).
Sounds more than a simple tendon lac to me
And no global on thatI got paid $1100 last year for a 11012 on a hallux done in the office. The patient and their insurance should have sent me a Christmas card.
My busiest month so far at the new job has been about 600wRVU all in and I was fairly busy...
1200 a month is ~800k salary for that provider. Not impossible but thats long hours.
Just got my 6 month data. I was wrong. Over 6 months I am averaging 710wRVU a month with my first 1-2 months being fairly slow so I am at least 800+ a month now. I dont think the Epic data month to month is accurate. The official numbers are way different.The person posting said the $15-20k pay was from consults and surgery, “call stuff” only and not clinic. At $55 per wRVU, and $17500 in pay for the week, that’s just over 300 wRVU on nothing but inpatient consults and cases. In one week. There is a 0% chance that it accurate. Even if they got $1000 per day to be on call (they don’t), it’s still 220+ wRVU generated from being on call only. It’s probably a well intentioned post…but it’s bogus
I only have around 80 encounters per week (clinic and cases combined) and I do between 500-600 wRVU. And I’m not busy at all. So I have no problem believing that a 300 wRVU week while on call at a busy hospital is totally possible. I’ve had friends who have had 1000-1200 wRVU months. But that has to include your clinic and scheduled outpatient cases as well.
I didn't find a resolution to this. Anyone know for sure?What if you do the procedure but it pays less than the 9921x? Can you just document the procedure but just bill the office visit instead? Because an injection pays less than a 99213.
I bill as you do by the way - but it just doesn’t make sense to me if I see a patient for a follow up for PF, and I do an injection, I can only bill the crappy injection code when I could technically just have made more money not giving them the shot but telling them to stretch for another month. Especially when you carry a risk for injections (infection, pain, tendon rupture, calls etc). Why the heck does it pay less than an office visit?
I didn't find a resolution to this. Anyone know for sure?
just did a matrixectomy on a new patient.The resolution is to bill the office visit. DYK’s billers won’t do this but, an unplanned visit due to exacerbation of symptoms likely allows for an e/m in many or most cases. Billing the injection alone is when the patient is coming in for a scheduled injection, or maybe in a chronic arthritis patient where your last note says to return as needed for repeat corticosteroid injection and you aren’t implementing additional therapies (ie Rx for AFO). Though, the injection alone wouldn’t pay much less than the scenario you quoted since telling a patient to “stretch for another month” alone is a level 2 visit.
That’s a lot of words to say, if you told the patient to come back for possible injection, and they are back for an injection, and you just give them an injection…you’re stuck getting paid $50-60 for an injection.
Sell them some Vionic shoes from your retail shop in your waiting room. Or some natural tea tree, antifungal nail polish like every other office in this dumb arse profession…
Agree with you.... 99202/3 and 11750 all the way.just did a matrixectomy on a new patient.
11750 is all my billers will allow me to bill.
I dont understand how if I meet a patient for the first time and do a physical exam to verify they are appropriate for minor surgery I cant bill an E&M. So dumb.
There might be something more going on here. I’m not hospital-based, so my level of interest in how they bill is trivial. But hospitals for medicare at least bill g0463 - hospital outpatient visit. Your coding is professional fee only which is trivial when compared to facility. Consider, the hospital gets the big pot. Adding your codes increases your RVU but trivially increases their reimbursement and may increase their cost in paying you. There has also been discussion on other forums that the 2021 rvu values were a drain on hospitals because doctor RVU went up but commercial insurance didn't increase rates. I believe I have read elsewhere on the forum about doctors indicating that their hospitals never agreed to pay at the 2021 rates.just did a matrixectomy on a new patient.
11750 is all my billers will allow me to bill.
I dont understand how if I meet a patient for the first time and do a physical exam to verify they are appropriate for minor surgery I cant bill an E&M. So dumb.
I am hospital based and I do e&m with matrixectomy and initially I had some pushback but now they allow it.just did a matrixectomy on a new patient.
11750 is all my billers will allow me to bill.
I dont understand how if I meet a patient for the first time and do a physical exam to verify they are appropriate for minor surgery I cant bill an E&M. So dumb.
just did a matrixectomy on a new patient.
11750 is all my billers will allow me to bill.
I dont understand how if I meet a patient for the first time and do a physical exam to verify they are appropriate for minor surgery I cant bill an E&M. So dumb.
just did a matrixectomy on a new patient.
11750 is all my billers will allow me to bill.
I dont understand how if I meet a patient for the first time and do a physical exam to verify they are appropriate for minor surgery I cant bill an E&M. So dumb.
This is unheard of in PP. Every new walking soul on the exam chair gets a 99203 or 99204 and then whatever procedure or DME follows. A new patient comes in for hand pain because they took a wrong exit and magically appear on my chair still gets billed a 99203 (for taking a patient slot) and wasting my time.just did a matrixectomy on a new patient.
11750 is all my billers will allow me to bill.
I dont understand how if I meet a patient for the first time and do a physical exam to verify they are appropriate for minor surgery I cant bill an E&M. So dumb.
This is unheard of in PP. Every new walking soul on the exam chair gets a 99203 or 99204 and then whatever procedure or DME follows. A new patient comes in for hand pain because they took a wrong exit and magically appear on my chair still gets billed a 99203 (for taking a patient slot) and wasting my time.
If you palpated pulses and checked CFT to see if your matrix would heal, looked at the skin and decided abx start/continue or not, looked for other PMFSH red flags for healing like tobacc or systemic, that's a 99203 for cellulitis and whatever (HAV, etc).just did a matrixectomy on a new patient.
11750 is all my billers will allow me to bill.
I dont understand how if I meet a patient for the first time and do a physical exam to verify they are appropriate for minor surgery I cant bill an E&M. So dumb.
11750 is technically a surgical procedure so I would say a level 4 with the avulsion since a decision is being made on surgeryThe only time you don’t bill an office visit with 11750 is if it’s a revision on the same toe. Otherwise…always billing w lvl 3 with it
11750 is minor surgery. Level 3.11750 is technically a surgical procedure so I would say a level 4 with the avulsion since a decision is being made on surgery
11750 is minor surgery. Level 3.
Yea exactly... The majority of patients getting 11750 are your typical healthy run of the mill patients. Unless PAD, DM, tobacco is your patient jam I'd be hard pressed to hear what risk factors made it a level 4 as your go toWith risk factors. Derp.
Yea exactly... The majority of patients getting 11750 are your typical healthy run of the mill patients. Unless PAD, DM, tobacco is your patient jam I'd be hard pressed to hear what risk factors made it a level 4 as your go to
Decreased pedal hair was notedInterdigital maceration was noted
Decreased pedal hair was noted
Add on RFC to the remaining nails for extra moolah... Shoot for 1 bullet in class B / C if you can also tack onLvl 5 ez
First, no need for that. Why can't someone post something, even if they are wrong and get clarification?With risk factors. Derp.
Which is why the two people who replied both said “with risk factors”Second it says "with identified patient or procedure risk factors".
What are the procedure risk factors of a chemical matrixectomy in a healthy 15 year old kid? And of whatever risk factors you list (make up), how frequent do they happen in your practice?but I don't read it that its the patient risk factors. I read it is procedure risk factors.
Ok so in all fairness there really arent any. It's a skin procedure. Are there extreme zebras like osteomyelitis, amputation or death? But for every run of the mill 11750 this is minor surgery. If you are doing it on patients that increase the chance of a bad outcome do you really want to be doing a chemical matrixectomy on them?I read it is procedure risk factors.
do you really want to be doing a chemical matrixectomy on them?
You should bill some/most of those at 10061 (prob level 3 visit)... more $ than 11730 (even with level 4 visit, which is a bit sketch without other issues, Rx, tests, etc) and 10061 is perfectly appropriate if they're the draining ones you have to block, rinse, maybe culture or debride and put on abx. The pedi shop prox nail fold abscess ones where you do a total avulsion + rinse + abx are often fitting for that also....If you had a really really nasty infected one on a patient with PAD to a point where you need to I&D/avulse it or risk further infection you could argue that as a level 4. But having had the misfortune of managing PAD patients who have had matrixes lead to amps from outside docs I really try to tiptoe around jumping to matrix for those when I can and usually avulse and irrigate instead.
I know you’ll see a lot of mustaches post on PMNews about how they phenol everything even the super infected ones with no problems - but I’ve only been in practice for 2 years and have seen too many matrixes go awry from outside docs being too aggressive whether it’s PAD or phenolizing aggressively with infection so I call BS on that.
I thank you a lot for being honest. I’m a third year and it’s hit me that this profession isn’t for me. I have done a lot of reflection on personal matters as well as taking into account the information you guys have provided here because the schools aren’t making us aware of these things. I’m not basing my decision solely on what has been stated on this forum but it is definitely something that I have taken heed to. Again I sincerely thank you all who speak out and are honest.You will see for yourself out on clerkships. There are the whole spectrum.
Some pod programs are long hours and pretty hard since they legitimately have much work, surgery, inpatients, academics, etc... this is maybe 25% of DPM residencies (usually the best training programs we have, provided they have reasonable variety of cases + attendings).
Some pod programs are long hours and fairly hard just for the sake of being hard (they don't have a ton of surgery but find ways to triple scrub it, take in-house call for nonsense like minimally infected wounds or stable fractures, see consults for dumb derm/nail stuff, etc). This is maybe another 15% of residencies.
Half of podiatry residencies are inadequate and essentially fudge logs, few academics or very low quality ones (yet some of them will find ways to work long hours anyways).
Overall, the majority of our podiatry residencies are a cakewalk compared to nearly any MD residency. That's largely because nearly all of theirs are at teaching centers and univ hospitals with high overall standards and good resources while many of ours for podiatry are at little community centers or VA hospitals with little oversight/accountability. You will see this if you do residency or rotate at major teaching hospital(s). Most MD programs are up early for inpatient rounds (juniors earlier than seniors, but all fairly early), then grand rounds or M&M or board prep or etc... then to legit busy surgery or clinic all day, prepping for boards more or doing research in some afternoons, occasional evening academics also, some residents on call overnight. Call is typically inpatient for at least one resident - esp for surgical specialties. Those type of average MD resident hours and academics and exp would only be seen at our best DPM programs, which are a small minority.
...the best thing to do if you want a country club program is to clerk and see for yourself. The senior/chief residents decide the program culture a bit too, so those might be the pgy1s or the pgy2s depending what time of year you clerk there. If you want a good program, pick accordingly. If you want easy hours, pick a lax place with a largely absent director and senior residents who don't run academics and usually leave early themselves - so they won't even notice if their juniors do. You can plan to be home by 4pm or earlier most days and not have to read much... and also plan to fail ABFAS qual and have limited job options after residency.
In all seriousness, I look at it this way: do the best residency you can get, work pretty hard (but avoid programs that are hard just for the sake of being hard). Later on, it's all downhill afterwards. For me, as an attending...
Going in occasionally for gas gangrene amp or the odd irreducible ankle fx is not bad... I did that 2-5x or more maaany nights as a resident.
Hard cases are not hard. I saw many that were much worse on residency pod or trauma, ortho, etc rotations.
Surgical planning is not bad... I've seen basically any and every type of fixation and implant in residency because I had so many attendings.
Tests are not tough... I simply have to review a bit to get back to a fraction of what I knew in residency when I read almost daily.
Getting up early for surgery a few days per month now is what I used to do almost every single day in residency.
I can do occasional clinic days on a half night's sleep since I did it hundreds of times in residency.
^If I would've chosen a low quality residency, that stuff would seem much harder... or impossible (assuming I could even get privileges).
...and, sadly enough, the real "burnout" comes probably about one year after residency graduation. That is when you face the rough realities of the podiatry job market, financials, and that being an associate is depressing. Don't say SDN doesn't warn you. Out in the real world of podiatry, you are forced to come to terms with the fact that you 95% won't have the opulent "doctor lifestyle" and ~50% might struggle to even have an upper middle class lifestyle. In residency, you can gleefully ignore those things, enjoy good health insurance, pretend you will be different and find a good job, and you don't have much time to spend $ you make anyways. For the first year out, you might not be happy with your job, but you don't realize right away how little ~$100k or $150k is after taxes and student loans. The way to weather that is to have a financially competent partner and/or frugal and realistic expectations. It will hit you hard, though. There is no getting around that for 90% or more of young DPMs.
I have a friend who was in DO school and he finished his 3rd year. He's a great student and all. After rethinking about his path and what he has to go through in the future (cons and pros), he quit medical school as it wasn't for him. He's way better off and a much happier person now. He's doing what he loves and that's flying. Everybody has their own choices and it's your future on what you decide to do. Good luck with everything.I thank you a lot for being honest. I’m a third year and it’s hit me that this profession isn’t for me. I have done a lot of reflection on personal matters as well as taking into account the information you guys have provided here because the schools aren’t making us aware of these things. I’m not basing my decision solely on what has been stated on this forum but it is definitely something that I have taken heed to. Again I sincerely thank you all who speak out and are honest.
Good luck. Once I got married and had kids I knew I could never leave podiatry. You have time to build up a meaningful career doing something else.I thank you a lot for being honest. I’m a third year and it’s hit me that this profession isn’t for me. I have done a lot of reflection on personal matters as well as taking into account the information you guys have provided here because the schools aren’t making us aware of these things. I’m not basing my decision solely on what has been stated on this forum but it is definitely something that I have taken heed to. Again I sincerely thank you all who speak out and are honest.