TABLES
Table 1. CPT and AP-DRG Codes Used in the Analysis
CPT Code
Description
Total RVU
31500
Insert emergency airway (i.e., intubation)
3.23
31600
Incision of windpipe (i.e., tracheostomy)
11.75
31624
Diagnostic bronchoscope/lavage
4.4
43246
Place gastrostomy tube
7.5
94002
Vent mgmt inpatient initial day
2.69
94003
Vent mgmt inpatient subsequent day
1.95
94004
Vent mgmt nursing facility per day
1.43
94014
Patient recorded spirometry
1.46
94668
Chest wall manipulation
0.8
99204
Office/outpatient visit, new
3.77
99205
Office/outpatient visit, new
4.84
99212
Office/outpatient visit, established
0.72
99213
Office/outpatient visit, established
1.46
99214
Office/outpatient visit, established
2.25
99222
Initial hospital care
3.96
99223
Initial hospital care
5.82
99231
Subsequent hospital care
1.12
99232
Subsequent hospital care
2.06
99233
Subsequent hospital care
2.97
99239
Hospital discharge day
3.08
99284
Emergency dept visit
3.37
1
Table 1. CPT and AP-DRG Codes Used in the Analysis (continued).
99285
Emergency dept visit
4.93
99291
Critical care first hour
6.4
99292
Critical care additional 30 min
3.22
99306
Nursing facility care init
4.83
99307
Nursing facility care subsequent
1.28
99308
Nursing facility care subsequent
1.99
99309
Nursing facility care subsequent
2.61
99310
Nursing facility care subsequent
3.89
99316
Nursing facility discharge day
3.01
99357
Prolonged service inpatient
2.62
99367
Team conference, nursing facility w/o pat by phys
1.62
99380
Nursing facility care supervision
2.54
DRG Relative
AP-DRG
Description
Weight 2012
Medicaid
Cost
79
Respiratory Infections & Inflammations, Adult, with Co-Morbidities
1.3102
$6,580
881
Respiratory System Diagnosis, Mechanical Ventilation 96+ Hours
5.6296
$28,272
882
Respiratory System Diagnosis, Mechanical Ventilation <96 Hours
2.208
$11,089
Respiratory System Diagnosis, Mechanical Ventilation 96+ Hours
2.0242
$63,000*
LTC-DRG
207
Average costs obtained from personal communication with Gary Huck, Director of Managed Care Operations
& Reimbursement at University Hospital, Newark, N. J.
*
2
Table 2. Comparison of RVUs and Facility Costs for Invasive versus Noninvasive Management
CASE 1
Pre-CMV Conventional
Management to Age 19
Item
RVU
CMV Conventional Management, Ages
19-48
Cost
Item
RVU
Cost
(2) manual WCs
--
$8,000
ARF admission
248
$28,275
(2) motorized WCs
--
$24,000
hospitalizations x4
224
$113,099
misc equipment
--
$1,870
LPN x10yrs
--
$2,271,360
(3) manual WCs
--
$12,000
(3) motorized WCs
--
$36,000
vent rental x10yrs
--
$96,000
546
$4,507,750
SNF x19yrs
0
$33,870
1,018 $7,064,484
CASE 2
Pre-CMV Noninvasive
Management with Part-Time
NIPPV, Ages 19-22
Item
RVU
Cost
Pre-CMV Hypothetical
Conventional Management to
Age 22
CMV Noninvasive Management,
Ages 23-48
Item
RVU
cost
(2) manual WCs
--
$8,000
outpatient x25 visits
92
--
(2) motorized WCs
--
$24,000
waiver x21yrs
--
$1,470,000
misc equipment
--
$1,330
outpatient x6 visits
26
--
vent rental x3yrs
--
$28,800
cough assist
--
$4,750
54
$62,130
at $70,000/yr
hospitalizations x4
361
$113,099
453
$1,583,099
item
RVU
cost
CMV Hypothetical
Conventional Management,
Ages 23-48
Item
RVU
Cost
(2) manual WCs
--
$8,000
ARF admission
123
$28,275
(2) motorized WCs
--
$24,000
SNF x25yrs
721
$5,931,250
misc equipment
--
$1,330
0
$33,330
843
$5,959,525
3
Table 2. Comparison of RVUs and Costs for Invasive versus Noninvasive Management (continued).
CASE 3
Pre-CMV Noninvasive
Management to Age 27 with
Part-Time NIPPV, Ages 26-27
Item
(3) manual WCs
(3) motorized WCs
misc equipment
outpatient x2 visits
vent rental 1yr
cough assist
RVU
---10
---
cost
$12,000
$36,000
$1,410
-$9,600
$4,750
10
$63,760
Pre-CMV Hypothetical
Conventional Management to
Age 27
CMV Noninvasive Management,
Ages 27-44
Item
outpatient x9 visits
waiver x15yrs
RVU
33
--
cost
-$432,000
33
$489,600
at $28,800/yr
item
(3) manual WCs
(3) motorized WCs
misc equipment
PSG & CPAP
RVU
---4
Cost
$12,000
$36,000
$1,410
$3,000
4
$52,410
CMV Hypothetical Conventional
Management, Ages 27-44
item
ARF admission
SNF x17yrs
RVU
123
490
cost
$28,275
$4,033,250
613
$4,061,525
CASE 4
Pre-CMV Hypothetical
Noninvasive Management to Age
26 then Part-Time NIPPV, Ages
26-28
CMV Noninvasive Management,
Ages 28-31
Item
(3) manual WCs
(3) motorized WCs
Item
outpatient x3 visits
vent rental x3yrs
misc equipment
vent rental x2yrs
cough assist
RVU
---
cost
$12,000
$36,000
----
$420
$19,200
$4,750
0
$72,370
RVU
10
--
-$28,800
Pre-CMV Conventional
Management to Age 26
Item
(3) manual WC
(3) motorized WC
misc equipment
admit: 15yo
admit: 26yo
10
$28,800
4
RVU
---
Cost
$12,000
$36,000
-75
75
$2,110
$6,580
$6,580
149
$63,261
CMV Conventional
Management from Age 26 to 28
then Hypothetical to Age 30
item
ARF admission
LTAC x49days
SNFx1year
27.5 237,250
SNF x3yrs
RVU
189
23
cost
$28,275
$63,000
110
82.5
$949,000
$771,750
322
$1,040,275
Table 2. Comparison of RVUs and Costs for Invasive versus Noninvasive Management (continued).
Pre-CMV-prior to dependence on continuous mechanical ventilation; CMV-while dependent on continuous mechanical ventilation
(hypothetical
estimates are italicized); WC-wheelchair; PAS-personal assistance services; vent-ventilator; MIE-mechanical
insufflator-exsufflator; ARF-acute respiratory failure; misc-miscellaneous; LPN-licensed practical nursing; SNF- skilled nursing care
facilities’ ventilator units; LTAC- long term acute care; PSG-polysomnogram; CPAP-continuous positive airway pressure.
Costs for Durable Medical Products and Services: Standard wheelchair $4000, motorized wheelchair $12,000 and miscellaneous
equipment including shower chair $80, commode $260, braces $300, and walkers $240 (personal communication, Carlos Collazo,
president at CMC Adaptive Seating & Homecare, LLC, Whippany, N. J.); ventilator $800/month, mechanical insufflator-exsufflator
$4000/year (personal communication, Louis Saporito, B.S., Millennium Respiratory Services, Whippany, N.J).; Personal assistance
services $11.45/hour (personal communication, Mr. Gary Novak, Trenton, N.J. (Figure 1)); and Licensed Practical Nurse services
$39/hour, personal communication, Ms. Arlene Gray, Newton, N.J..
5
APPENDIX 1 - Detailed Case Cost and RVU Analysis
Abbreviations used in the Appendix: addl - additional, ARF - acute respiratory failure, CMV - dependence on continuous mechanical ventilation,
CPAP - continuous positive airway pressure, dept - department, DRG - diagnosis-related group, est. - established, eval - evaluation, fac - facility, init
- initial, inpat - inpatient, LPN-licensed practical nursing; LTAC - long term acute care ventilator unit, mgmt - management, MIE-mechanical
insufflator-exsufflator; NIV - noninvasive ventilation, NNIV - nocturnal noninvasive ventilation, pre-CMV – ventilator use less than 24 hours per
day, RVU - relative value unit, PAS - personal assistance service, PSG - polysomnography, subsq - subsequent, SNCF- skilled nursing care facilities’
ventilator units; supervis - supervision, vent - ventilator, VNS - visiting nurse service, WC - wheelchair
Case 1.
Conventional Management - Pre-CMV
Equipment
wheelchair
manual
motorized
misc equipment
hoyer lift
shower chair
commode
braces
walkers
Count
Unit Cost
Cost
2
2
$4,000
$12,000
$8,000
$24,000
1
1
2
2
2
$990
$80
$130
$150
$120
$990
$80
$260
$300
$240
$33,870
Conventional Management - CMV
Admission - Trached
COST:
$28,275
Physicians' Service
99285 Emergency dept visit
Hospitalist x 1 day
99291 Critical care first hour
days
Inpatient Pulm
63
99291 Critical care first hour
days
4
99292
Critical care addl 30 min
99233 Subsq hospital care
99232
Subsq hospital care
94003 Vent mgmt inpat subsq day
99357 Prolonged service inpatient
99239 Hospital discharge day
5
days
Inpatient Neurology
99223 Consultant's initial hospital care
99233 Consultant's subsq hospital care
99232 Consultant's subsq hospital care
4
days
Inpatient Surgeons
99223 Consultant's initial hospital care
Item
Count
1
Base
RVU
4.93
Total
RVU
4.9
1
6.4
6.4
6.4
25.6
3.2
71.3
41.2
27.3
5.2
3.1
4
1
24
20
14
2
1
3.22
2.97
2.06
1.95
2.62
3.08
1
2
2
5.82
2.06
5.8
5.9
4.1
1
5.82
5.8
2.97
99233
99232
Consultant's subsq hospital care
Consultant's subsq hospital care
2
1
2.97
2.06
5.9
2.1
31500
Procedures/Other
Insert emergency airway
1
3.23
3.2
6
Facility
Cost
31600
Incision of windpipe
1
11.8
11.8
31641
Bronchoscopy treat blockage
1
7.67
7.7
43246
Place gastrostomy tube
1
7.5
7.5
Facility's Payment
AP-DRG 881 base $5,022 * DRG weighted rate 5.6296
1
$28,275
248
Home Expensese
$28,275
Count
Unit Cost
Cost
manual
3
$4,000
$12,000
motorized
3
$12,000
$36,000
1
$800/month
$96,000
Equipment
wheelchair
vent rental - 10 years
Visiting Nurse Service - 16hrs/day at $39/hr x 10years
$2,271,360
$2,415,360
Nursing Home
COST:
$4,507,750
Physicians' Service
99306
Inpatient eval - monthly
Nursing facility care init
99310
Nursing fac care subseq
228
Item
Count
Base
RVU
1
Total
RVU
times
4.83
4.8
12
3.89
46.7
99309
Nursing fac care subseq
72
2.61
187.9
99308
Nursing fac care subseq
100
1.99
199.0
Nursing fac care subseq
99307
24
1.28
30.7
94004
Vent mgmt nf per day
20
1.43
28.6
99380
Nursing fac care supervision - annual
19
2.54
48.3
Facility's Payment
Per diem rate $650 per day
Multiple Hospitalizations
6935
COST:
$113,099
Physicians' Service
$4,507,750
546
$4,507,750
Facility
Cost
Item
Count
Base
RVU
Total
RVU
4
3.37
13.48
2
11.9
23.244
99284
Emergency dept visit
99223
Hospitalist
Initial hospital care
99291
Critical care first hour
2
8
15.6
99233
Subsq hospital care
6
2.97
17.3745
20
days
99232
Subsq hospital care
7
2.06
14.0595
99231
Subsq hospital care
2
1.12
2.184
1
3.08
3.08
1
5.82
5.82
3
8
24
99239
Hospital discharge day
99223
35
Pulm
Consultant's initial hospital care
99291
Consultant's critical care first hour
Facility
Cost
days
99233
Consultant's subsq hospital care
12
2.97
36.3825
99232
Consultant's subsq hospital care
14
7
2.06
28.84
99231
Consultant's subsq hospital care
5
Facility's Payment
AP-DRG 881 base $5,022 * DRG weighted rate 5.6296
1.12
5.88
$113,099
4
223.6
$113,099
Case 1 Grant Total
$7,098,354
Case 2.
Noninvasive Management - Pre-CMV
Equipment
wheelchair†
manual
motorized
misc equipment
hoyer lift
shower chair
commode
cough assist‡
vent rental‡ - 3 years
Count
Unit Cost
Cost
2
2
$4,000
$12,000
$8,000
$24,000
1
1
2
1
1
$990
$80
$130
$4,750
$800/month
$990
$80
$260
$4,750
$28,800
$66,880
Outpatient Mgmt
Physicians' Service
99204 Office/outpatient visit new
6
99214 Office/outpatient visit est.
99213
Office/outpatient visit est.
99212
Office/outpatient visit est.
94014 Patient recorded spirometry - each visit
Item
Count
1
1
3
2
6
visits
Base
RVU
4.84
3.14
2.14
1.29
1.46
Total
RVU
4.8
3.1
6.4
2.6
8.8
25.7
Noninvasive Management - CMV
Outpatient Mgmt
Physicians' Service
99204 Office/outpatient visit new
25
99214 Office/outpatient visit est.
99213
Office/outpatient visit est.
99212
Office/outpatient visit est.
94014 Patient recorded spirometry - each visit
Item
Count
0
5
16
4
25
visits
Base
RVU
4.84
3.14
2.14
1.29
1.46
Total
RVU
0.0
15.7
34.2
5.2
36.5
91.6
Average costs obtained from personal communication with Carlos Collazo, president at CMC Adaptive Seating & Homecare,
LLC, Whippany, N. J.
†
‡Average
cost obtained from personal communication with Lou Saporito B.S, respiratory therapist at Millennium Respiratory
Services, Whippany, N. J.
8
Medicaid Waiver Program
COST:
$1,470,000
Continuous NIV Waiver - $5833/month
Item
Count
Total Cost
21 years
$1,470,000
$1,470,000
Multiple Hospitalizations
COST:
$113,099
Physicians' Service
Item
Count
Base
RVU
Total
RVU
4
3.37
13.5
2
5.82
11.6
99284
Emergency dept visit
99223
Hospitalist
Initial hospital care
99291
Critical care first hour
2
6.4
12.8
99233
Subsq hospital care
21
days
6
2.97
17.8
99232
Subsq hospital care
7
2.06
14.4
99231
Subsq hospital care
2
1.12
2.2
2
3.08
6.2
2
5.82
11.6
99239
Hospital discharge day
99223
19
Inpatient - Pulm
Consultant's initial hospital care
99291
Consultant's critical care first hour
2
6.4
12.8
99233
Consultant's subsq hospital care
6
2.97
17.8
days
99232
Consultant's subsq hospital care
7
2.06
14.4
99231
Consultant's subsq hospital care
2
1.12
2.2
2
5.82
11.6
1
2.97
3.0
1
2.06
2.1
99223
4
Inpatient - Neurology
Consultant's initial hospital care
99233
Consultant's subsq hospital care
99232
Facility
Cost
days
Consultant's subsq hospital care
Facility's Payment
AP-DRG 881 base $5,022 * DRG weighted rate 5.6296
4
$113,099
361.0
$113,099
Noninvasive Mgmt Grant Total
$1,649,979
Hypothetical Conventional Management - Pre-CMV
Equipment
Count
Unit Cost
Cost
manual
2
$4,000
$8,000
motorized
2
$12,000
$24,000
hoyer lift
1
$990
$990
shower chair
1
$80
$80
commode
2
$130
$260
wheelchair
misc equipment
$33,330
Hypothetical Conventional Management - CMV
9
Admission - Trached
COST:
$28,275
Physicians' Service
Item
Count
Base
RVU
Total
RVU
99285
Emergency dept visit
1
4.93
4.9
99291
Hospitalist x 1 day
Critical care first hour
1
6.4
6.4
99291
Inpatient Pulm
Critical care first hour
2
6.4
12.8
1
3.22
3.2
5
2.97
14.9
4
2.06
8.2
2
Critical care addl 30 min
99292
99233
14
days
days
Subsq hospital care
99232
Subsq hospital care
94003
Vent mgmt inpat subsq day
2
1.95
3.9
99357
Prolonged service inpatient
2
2.62
5.2
99239
Hospital discharge day
1
3.08
3.1
99223
5
Inpatient - Neurology
Consultant's initial hospital care
1
5.82
5.8
99233
Consultant's subsq hospital care
2
2.97
5.9
99232
Consultant's subsq hospital care
2
2.06
4.1
99223
4
Inpatient - Surgeons
Consultant's initial hospital care
1
5.82
5.8
99233
Consultant's subsq hospital care
2
2.97
5.9
1
2.06
2.1
31500
Procedures/Other
Insert emergency airway
1
3.23
3.2
31600
Incision of windpipe
1
11.8
11.8
31641
Bronchoscopy treat blockage
1
7.67
7.7
43246
Place gastrostomy tube
1
7.5
7.5
Facility's Payment
AP-DRG 881 base $5,022 * DRG weighted rate 5.6296
1
99232
days
days
Consultant's subsq hospital care
Nursing Home
COST:
$5,931,250
Physicians' Service
99306
Inpatient eval - monthly
Nursing facility care init
99310
Nursing fac care subseq
Facility
Cost
300
$28,275
122.5
$28,275
Facility
Cost
Item
Count
Base
RVU
Total
RVU
1
4.83
4.8
16
3.89
62.2
times
99309
Nursing fac care subseq
96
2.61
250.6
99308
Nursing fac care subseq
134
1.99
266.7
99307
Nursing fac care subseq
27
1.28
34.6
94004
Vent mgmt nf per day
27
1.43
38.6
99380
Nursing fac care supervision - annual
25
2.54
63.5
Facility's Payment
Per diem rate $650 per day
9125
$5,931,250
721.0
Conventional Mgmt Grant Total
10
$5,931,250
$5,992,855
Case 3.
Noninvasive Management - Pre-CMV
Equipment
wheelchair
manual
motorized
misc equipment
hoyer lift
shower chair
commode
cough assist
vent rental - 1 year
Count
Unit Cost
Cost
3
3
$4,000
$12,000
$12,000
$36,000
1
2
2
1
1
$990
$80
$130
$4,750
$800/month
$990
$160
$260
$4,750
$9,600
$63,760
Outpatient Mgmt
Physicians' Service
99204 Office/outpatient visit new
2
99214 Office/outpatient visit est.
visits
99213
Office/outpatient visit est.
99212
Office/outpatient visit est.
94014 Patient recorded spirometry - each visit
Item
Count
1
0
1
0
2
Base
RVU
4.84
3.14
2.14
1.29
1.46
Total
RVU
4.8
0.0
2.1
0.0
2.9
9.9
Noninvasive Management - CMV
Outpatient Mgmt
Physicians' Service
99204 Office/outpatient visit new
9
99214 Office/outpatient visit est.
visits
99213
Office/outpatient visit est.
99212
Office/outpatient visit est.
94014 Patient recorded spirometry - each visit
Item
Count
0
1
7
1
9
Base
RVU
4.84
3.14
2.14
1.29
1.46
Total
RVU
0.0
3.1
15.0
1.3
13.1
32.6
Medicaid Waiver Program
COST:
$432,000
Continuous NIV Waiver - $2400/month x 15 years
Item
Count
Total Cost
1
$432,000
$432,000
Noninvasive Mgmt Grant Total
$495,760
Conventional Management - Pre-CMV
Equipment
wheelchair
manual
motorized
Count
Unit Cost
Cost
3
3
$4,000
$12,000
$12,000
$36,000
11
misc equipment
hoyer lift
shower chair
commode
1
2
2
$990
$80
$130
$990
$160
$260
$49,410
Polysomnography & CPAP
COST:
$3,000
PSG & CPAP
99091
Collect/review data from pt
99213
Office/outpatient visit est.
Tests Cost
Item
Count
Base
RVU
Total
RVU
1
1.62
1.6
1
2.14
2.1
1
Total Cost
$3,000
3.8
$3,000
Facility
Cost
Hypothetical Conventional Management - CMV
Admission - Trached
COST:
$28,275
Physicians' Service
Item
Count
Base
RVU
Total
RVU
99285
Emergency dept visit
1
4.93
4.9
99291
Hospitalist x 1 day
Critical care first hour
1
6.4
6.4
99291
Inpatient Pulm
Critical care first hour
2
6.4
12.8
1
3.22
3.2
5
2.97
14.9
4
2.06
8.2
days
days
2
Critical care addl 30 min
99292
99233
14
Subsq hospital care
99232
Subsq hospital care
94003
Vent mgmt inpat subsq day
2
1.95
3.9
99357
Prolonged service inpatient
2
2.62
5.2
99239
Hospital discharge day
1
3.08
3.1
99223
5
Inpatient - Neurology
Consultant's initial hospital care
1
5.82
5.8
99233
Consultant's subsq hospital care
2
2.97
5.9
99232
Consultant's subsq hospital care
2
2.06
4.1
99223
4
Inpatient - Surgeons
Consultant's initial hospital care
1
5.82
5.8
99233
Consultant's subsq hospital care
2
2.97
5.9
1
2.06
2.1
31500
Procedures/Other
Insert emergency airway
1
3.23
3.2
31600
Incision of windpipe
1
11.8
11.8
31641
Bronchoscopy treat blockage
1
7.67
7.7
43246
Place gastrostomy tube
1
7.5
7.5
99232
days
days
Consultant's subsq hospital care
Facility's Payment
AP-DRG 881 base $5,022 * DRG weighted rate 5.6296
Nursing Home
Physicians' Service
COST:
$4,033,250
1
Item
Count
12
$28,275
Base
RVU
122.5
$28,275
Total
RVU
Facility
Cost
99306
Inpatient eval - monthly
Nursing facility care init
99310
Nursing fac care subseq
204
times
1
4.83
4.8
10
3.89
38.9
99309
Nursing fac care subseq
65
2.61
169.7
99308
Nursing fac care subseq
93
1.99
185.1
99307
Nursing fac care subseq
18
1.28
23.0
94004
Vent mgmt nf per day
18
1.43
25.7
99380
Nursing fac care supervision - annual
17
2.54
43.2
Facility's Payment
Per diem rate
17
years
$650 per day
$4,033,250
490.4
$4,033,250
Conventional Mgmt Grant Total
$4,113,935
Case 4.
Hypothetical Noninvasive Management - Pre-CMV
Equipment
wheelchair
manual
motorized
misc equipment
hoyer lift
shower chair
commode
cough assist
vent rental - 2 years
Count
Unit Cost
Cost
3
3
$4,000
$12,000
$12,000
$36,000
1
2
2
1
1
$990
$80
$130
$4,750
$800/month
$990
$160
$260
$4,750
$19,200
$73,360
Hypothetical Noninvasive Management - CMV
Outpatient Mgmt (CRS)
Physicians' Service
99204 Office/outpatient visit new
3
99214 Office/outpatient visit est.
visits
99213
Office/outpatient visit est.
99212
Office/outpatient visit est.
94014 Patient recorded spirometry - each visit
Item
Count
0
0
2
1
3
Base
RVU
4.84
3.14
2.14
1.29
1.46
Total
RVU
0.0
0.0
4.3
1.3
4.4
10.0
Equipment
vent rental - 3 years
Count
1
Unit Cost
$800/month
Cost
$28,800
$28,800
Noninvasive Mgmt Grant Total
$102,160
13
Conventional Management - Pre-CMV
Equipment
wheelchair
manual
motorized
misc equipment
hoyer lift
shower chair
commode
ankle-foot orthosis
walker
Count
Unit Cost
Cost
3
3
$4,000
$12,000
$12,000
$36,000
1
$990
$990
2
2
3
2
$80
$130
$150
$120
$160
$260
$450
$240
$50,100
Admission @ 15
COST:
Physicians' Service
99284 Emergency dept visit
10
Hospitalist
99223 Initial hospital care
99233 Subsq hospital care
99232
Subsq hospital care
$6,580
Subsq hospital care
Hospital discharge day
10
days
Inpatient - Pulm
99223 Consultant's initial hospital care
99233 Consultant's subsq hospital care
99232
Consultant's subsq hospital care
99231
Consultant's subsq hospital care
2
days
Inpatient - Neurology
99223 Consultant's initial hospital care
99233 Consultant's subsq hospital care
99232
Consultant's subsq hospital care
Facility's Payment
AP-DRG 79 base $5,022 * DRG weighted rate 1.3102
Admission @ 26
COST:
$6,580
Physicians' Service
99284 Emergency dept visit
10
days
Hospitalist
99223 Initial hospital care
99233 Subsq hospital care
99232
Subsq hospital care
99231
Subsq hospital care
99239 Hospital discharge day
10
days
Inpatient - Pulm
99223 Consultant's initial hospital care
99233 Consultant's subsq hospital care
99232
Consultant's subsq hospital care
99231
Consultant's subsq hospital care
2
days
Inpatient - Neurology
99223 Consultant's initial hospital care
99232
Base
RVU
1
3
4
5.82
1
1
1.12
1
3
5
1
5.82
1
0
1
5.82
3.37
Total
RVU
13.5
Facility
Cost
days
99231
99239
99233
Item
Count
4
Consultant's subsq hospital care
Consultant's subsq hospital care
2.97
2.06
3.08
2.97
2.06
1.12
2.97
2.06
5.8
8.9
8.2
1.1
3.1
5.8
8.9
10.3
1.1
5.8
0.0
2.1
1
$6,580
74.7
$6,580
Total
RVU
13.5
Facility
Cost
Item
Count
4
Base
RVU
1
3
4
1
1
5.82
2.97
1
3
5
1
5.82
1.12
5.8
8.9
10.3
1.1
1
5.82
5.8
0
2.97
0.0
1
2.06
2.1
14
3.37
2.06
1.12
3.08
2.97
2.06
5.8
8.9
8.2
1.1
3.1
Facility's Payment
AP-DRG 79 base $5,022 * DRG weighted rate 1.3102
1
$6,580
74.7
$6,580
Conventional Management - CMV from Age 26 to 27
Readmission - Trached
COST: $28,275
Physicians' Service
99285 Emergency dept visit
Hospitalist x 1 day
99291 Critical care first hour
days
Inpatient Pulm
32
99291 Critical care first hour
days
4
99292
Critical care addl 30 min
99233 Subsq hospital care
99232
Subsq hospital care
94003 Vent mgmt inpat subsq day
99357 Prolonged service inpatient
99239 Hospital discharge day
Item
Count
1
4.93
Total
RVU
4.9
1
6.4
6.4
4
2
14
10
5
2
1
6.4
3.08
25.6
6.4
41.6
20.6
9.8
5.2
3.1
1
5.82
5.8
Base
RVU
3.22
2.97
2.06
1.95
2.62
99223
5
Inpatient - Neurology
Consultant's initial hospital care
99233
Consultant's subsq hospital care
2
2.97
5.9
99232
Consultant's subsq hospital care
2
2.06
4.1
99223
5
Inpatient - Surgeons
Consultant's initial hospital care
1
5.82
5.8
99233
Consultant's subsq hospital care
2
2.97
5.9
2
2.06
4.1
31500
Procedures/Other
Insert emergency airway
2
3.23
6.5
31600
Incision of windpipe
1
11.8
11.8
31641
Bronchoscopy treat blockage
1
7.67
7.7
43246
Place gastrostomy tube
1
7.5
7.5
99232
days
days
Consultant's subsq hospital care
Facility's Payment
AP-DRG 881 base $5,022 * DRG weighted rate 5.6296
Age 26 - LTACH x 49 days
COST:
$63,000
Physicians' Service
99222
Inpatient eval - weekly
Initial hospital care
99233
Subsq hospital care
99232
7
1
$28,275
188.8
$28,275
Facility
Cost
Item
Count
Base
RVU
Total
RVU
1
3.96
4.0
1
2.97
3.0
2
2.06
4.1
times
Subsq hospital care
94003
Vent mgmt inpat subsq day
2
1.95
3.9
99239
Hospital discharge day
1
3.08
3.1
99367
Team conf w/o pat by phys - every other week
3
1.62
4.9
Facility's Payment
LTC-DRG 207
Facility
Cost
49
$63,000
22.9
15
$63,000
Hypothetical Conventional Management - CMV from Age 27 to 30
Nursing Home
COST:
$949,000
Physicians' Service
99306
Inpatient eval - monthly
Nursing facility care init
99310
Nursing fac care subseq
48
Item
Count
Base
RVU
Total
RVU
1
4.83
4.8
2
3.89
7.8
Facility
Cost
times
99309
Nursing fac care subseq
15
2.61
39.2
99308
Nursing fac care subseq
26
1.99
51.7
99307
Nursing fac care subseq
4
1.28
5.1
94004
Vent mgmt nf per day
1
1.43
1.4
99380
Nursing fac care supervision - annual
0
3.04
0.0
Facility's Payment
Per diem rate $650 per day
$949,000
110.1
Conventional Mgmt Grant Total
$1,103,536
16
$949,000