Question

3. Use table W7.2 and table W7.3 to answer the following questions. Table W7.2. Sample RVUs for selected HCPCS Codes HCPCS Code Description Work RVU Practice Expense RVU Malpractice Expense RVU 99203 Office Visit 1.23 0.48 0.09 99204 Office Visit 2.00 0.71 0.12 10080 I&D of pilonidal cyst, simple 1.17 1.11 0.11 45380 Colonoscopy with biopsy 4.43 1.73 0.35 52601 TURP, complete 12.35 5.1 0.87 Table W7.3. Sample GPCIs for selected U.S. Cities City Work GPCI Practice Expense GPCI Malpractice Expense GPCI St. Louis 1.000 0.946 0.941 Dallas 1.010 1.063 1.061 Seattle 1.010 1.115 0.819 Philadelphia 1.020 1.098 1.386 a. How much can a physician in St. Louis bill Medicare for an office visit for a new patient with a detailed history and physical and low-complexity medical decision making (assuming the patient has met any deductible for the year)? Assume a conversion factor of $34.0682 b. In which city would a physician receive the highest reimbursement for a TURP? c. In which city would a physician receive the lowest reimbursement for a colonoscopy with biopsy? d. Calculate the expected payment for an incision and drainage of a pilonidal cyst in each of the cities listed. Conversion Factor: $34.0682

City	Work GPCI	Practice Expense GPCI	Malpractice Expense GPCI
St. Louis	1.000	0.946	0.941
Dallas	1.010	1.063	1.061
Seattle	1.010	1.115	0.819
Philadelphia	1.020	1.098	1.386

Answer 1

a) St. Louis physician's Billing for office visit (HCPCS code 99203) = ( wRVU * wGPCI + peRVU * peGPCI + mRVU * mGPCI) * CF = (1.000*1.23 + 0.946*0.48 + 0.941*0.09)*34.0682 = $ 60.26

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b) Highest reimbursement for TURP

St. Louis =(1.000*12.35 + 0.946*5.1 + 0.941*0.87)*34.0682 = $ 613.00

Dallas =(1.010*12.35 + 1.063*5.1 + 1.061*0.87)*34.0682 = $ 641.09

Seattle =(1.010*12.35 + 1.115*5.1 + 0.819*0.87)*34.0682 = $ 642.95

Philadelphia =(1.020*12.35 + 1.098*5.1 + 1.386*0.87)*34.0682 = $ 661.01   (highest)

ANSWER: Philadelphia

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c) Lowest reimbursement for colonoscopy with biopsy

St. Louis =(1.000*4.43 + 0.946*1.73 + 0.941*0.35)*34.0682 = $ 217.90  (lowest)

Dallas =(1.010*4.43 + 1.063*1.73 + 1.061*0.35)*34.0682 = $ 227.73

Seattle =(1.010*4.43 + 1.115*1.73 + 0.819*0.35)*34.0682 = $ 227.91

Philadelphia =(1.020*4.43 + 1.098*1.73 + 1.386*0.35)*34.0682 = $ 235.18

ANSWER: St. Louis

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d) Expected payment for an incision and drainage of a pilonidal cyst in each of the cities

St. Louis =(1.000*1.17 + 0.946*1.11 + 0.941*0.11)*34.0682 = $ 79.16

Dallas =(1.010*1.17 + 1.063*1.11 + 1.061*0.11)*34.0682 = $ 84.43

Seattle =(1.010*1.17 + 1.115*1.11 + 0.819*0.11)*34.0682 = $ 85.49

Philadelphia =(1.020*1.17 + 1.098*1.11 + 1.386*0.11)*34.0682 = $ 87.37